Incidence of Achilles tendinopathy and associated risk factors in recreational runners: A large prospective cohort study

Published:December 19, 2019DOI:



      To determine the incidence of Achilles tendinopathy in a large group of recreational runners and to determine risk factors for developing AT.


      Observational cohort study.


      Runners registering for running events (5–42 km) in the Netherlands were eligible for inclusion. Main inclusion criteria were: age ≥18 years, and registration ≥2 months before the running event. The digital baseline questionnaire obtained at registration consisted of demographics, training characteristics, previous participation in events, lifestyle and previous running-related injuries. All participants received 3 follow-up questionnaires up to 1 month after the running event with self-reported AT as primary outcome measure. To study the relationship between baseline variables and AT onset, multivariable logistic regression analyses were performed.


      In total, 2378 runners were included, of which 1929 completed ≥1 follow-up questionnaire, and 100 (5.2%, 95%CI [4.2;6.2]) developed AT. Runners registered for a marathon (7.4%) had the highest incidence of AT. Risk factors for developing AT were use of a training schedule (odds ratio (OR) = 1.8 (95%Confidence Interval(CI)[1.1;3.0])), use of sport compression socks ((OR = 1.7, 95%CI[1.0;2.8]) and AT in the previous 12 months (OR = 6.3, 95%CI[3.9;10.0]). None of the demographic, lifestyle or training-related factors were associated with the onset of AT.


      One in twenty recreational runners develop AT. AT in the preceding 12 months is the strongest risk factor for having AT symptoms. Using a training schedule or sport compression socks increases the risk of developing AT and this should be discouraged in a comparable running population.

      Trial registration number

      The Netherlands Trial Register (ID number: NL5843).


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