Lower limb biomechanical factors associated with Achilles tendinopathy in runners: a systematic review

Key points

1. 01This systematic review pooled observational and prospective biomechanical studies of runners with Achilles tendinopathy.
2. 02Reported associated factors include altered foot pronation, reduced ankle dorsiflexion, high training load, and kinematic or kinetic asymmetries.
3. 03The authors describe the cause as multifactorial rather than driven by one mechanism.
4. 04Evidence quality across the included studies was variable, so findings should be read with caution.
5. 05The authors suggest biomechanical screening may inform load management and rehabilitation targets.

How it was conducted

Design

Systematic review of observational and prospective biomechanical studies

Population

Runners with Achilles tendinopathy

Focus

Lower limb biomechanical factors associated with the condition

Outcomes assessed

Foot pronation, ankle dorsiflexion, training load, and lower limb kinematic and kinetic asymmetries

What they found

• The review reports altered foot pronation, reduced ankle dorsiflexion, high training load, and kinematic or kinetic asymmetries as factors linked to Achilles tendinopathy in runners.
• The authors note that the quality of the underlying evidence was variable.

Limitations

• The available text reports no included-study count, sample sizes, effect sizes, or statistical estimates, so the strength of each association cannot be quantified here.
• Evidence quality across included studies was described as variable.
• Many included studies were observational, which limits conclusions about cause and effect.
• The multifactorial findings mean no single biomechanical factor can be used in isolation to identify or predict the condition.

Why it matters

For patients

If you run and have Achilles pain, several factors such as foot mechanics, ankle flexibility, and how quickly you increase training may all play a part rather than one single cause.

For clinicians

Consider a multifactorial biomechanical assessment, including foot pronation, ankle dorsiflexion, training load, and lower limb asymmetries, when evaluating runners with Achilles tendinopathy.

For readers

This review frames Achilles tendinopathy in runners as multifactorial and built on evidence of variable quality, so individual associations should be interpreted cautiously.