Execution
- 1Position the patient prone or standing with the Achilles tendon accessible.
- 2Palpate along the Achilles tendon to identify the point of maximal tenderness.
- 3Move the ankle into maximal dorsiflexion.
- 4Palpate the same tendon point again in dorsiflexion.
- 5Note whether tenderness disappears, decreases, or remains unchanged.
Positive outcome
The test is positive for Achilles tendinopathy when focal Achilles tenderness decreases or disappears in dorsiflexion compared with relaxed palpation. This is the Achilles version of the Royal London Hospital test and should not be confused with the patellar tendon version used at the knee. Persistent nonmoving superficial tenderness may suggest paratendon or non-tendinous pain.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Maffulli et al. (2003) | reproducibility and validity study | 54 | 91 | 6.0 | 0.51 |
| Hutchison et al. (2013) | systematic review | NA | NA | NA | NA |
| Reiman et al. (2014) | systematic review | NA | NA | NA | NA |
CommentRoyal London has better specificity than sensitivity, so it is more useful when positive than when negative. Reviews find mixed validity across Achilles tendinopathy tests, and pain on palpation often performs similarly or better. Use it with pain location, load history, tendon thickening, arc sign, and functional loading tests.
Moderate Clinical Value