Introduction
Several Achilles tendon-related disorders can be distinguished and for each pathology different definitions and terms or eponyms arose over time. As a result, the terminology for Achilles tendon-related disorders is inconsistent and confusing [
8,
17].
Initially terms were used such as “cellulite peritendineuse”, “tendinitis Achillae traumatica”, “paratendinitis”, “tenosynovitis” and “peritendinitis” [
10,
18]. The term ‘achillodynia’ was introduced as a descriptive term for Achilles tendon-related pain [
1]. Subsequently terms were based on histological findings and a subdivision was made into insertional and non-insertional Achilles tendon problems [
7,
14,
16]. Maffulli et al. [
12] observed that terminology used for tendon conditions was misused and confusing. In their opinion definitions as tendinitis, tendinosis and paratendonitis can only be diagnosed after biopsy; however, they were often used in clinical practice without histopathologic examination. Due to a lack of consistence in nomenclature, Maffulli et al. advocated to use the term tendinopathy to describe clinical overuse conditions around the tendon characterized by pain, swelling and impaired performance [
12]. Depending on the affected tissue, the terms tendinopathy, paratendinopathy or pantendinopathy were proposed.
In 2011, an addition was proposed to further purify the terminology used in Achilles tendon-related disorders to effectuate uniform and clear terminology [
24]. This terminology is based on anatomic location, symptoms, clinical findings and histopathology and consists of the following five terms: mid-portion Achilles tendinopathy, insertional Achilles tendinopathy, Achilles paratendinopathy, retrocalcaneal bursitis and superficial calcaneal bursitis [
24].
Uniform terminology provides the ability to communicate with an universal language in daily practice amongst clinicians and researchers. The aims of this study are to evaluate the current terminology and assess the influence of the latest proposals on the current terminology used for Achilles tendon-related disorders in both daily practice and literature.
Discussion
The main findings of this study were that terminology for Achilles tendon-related disorders according to the latest proposals based on anatomic location, symptoms, clinical findings and histopathology is being used by the majority of orthopedic surgeons in daily practice and is increasingly being used in the literature. However, the indistinct Haglund eponyms are still frequently used in Achilles tendon-related terminology.
The wide variety in terminology for Achilles tendon-related disorders is confusing. The term that represents the entity must be neutral yet descriptive, uniform and clear. Therefore, descriptive terms are preferable to eponymous terms [
21]. Terminology which includes the combination of anatomic location, symptoms and clinical findings and pathological changes for each entity has, therefore, been advocated.
Symptoms around the Achilles tendon often have a similar presentation and it is, therefore, important to define the pathology or the combination of pathologies. For example, lack of distinction between entities, such as insertional tendinopathy and chronic retrocalcaneal bursitis is crucial to determine further treatment and it impedes the process for researchers to perform an all-encompassing systematic review [
3,
27].
In five out of six cases in the survey, the majority of orthopedic surgeons gave a diagnosis according to the terminology based on anatomic location, symptoms, clinical findings and histopathology. The exception is the fifth case, where the majority choose Haglund’s disease instead of retrocalcaneal bursitis. A possible reason for this is the ingrained use of the eponym Haglund. There are approximately 20,000 medical eponymous terms in use today and the literature shows that using eponymous terms is an inaccurate and unreliable method of communication [
4,
5,
21]. Somford et al. questioned 244 orthopedic surgeons worldwide on common eponymous terms and reported a low agreement on use of eponymous terms (kappa 0.11; proportion of agreement, 68%). Nevertheless, eponymous terms are often used in clinical setting and are passed onto the residents and students [
11,
15,
22,
26]. Also, eponymous terms used in the published articles are often inconsistent and do not match their original definition [
20,
23].
Terminology in which Haglund eponyms such as Haglund’s deformity, Haglund’s syndrome and Haglund’s disease are all dissimilar entities should be avoided, because there is a large variation in the presumed meaning of these eponymous terms [
21]. Haglund’s syndrome was first defined as a common cause of posterior heel pain, characterized clinically by a painful soft tissue swelling at the level of the Achilles tendon insertion [
13]. Haglund’s deformity was first described as a tender swelling in the region of the Achilles tendon with visible prominence of the postero-lateral aspect of the calcaneus [
25]. Haglund’s disease, however, refers to osteochondrosis of the accessory navicular bone [
6,
19].
In systematic reviews, many eponymous diagnosis have to be converted to anatomical diagnostic groupings and at all studies are excluded based on aberrant or uninterpretable definitions of an eponym or pathology, which can lead to different research results which are often leading for the best scientific-based treatment in clinical practice [
2,
9,
27].
The survey was sent to members of the Ankleplatform Study Group, which caused selection bias. Even though orthopaedic surgeons from over the whole world responded, these were specifically experienced in the field of foot and ankle pathology what could have led to an overestimation of the terms used compared by orthopaedic surgeons in general. Also, the presumed definitions of the terms used for Achilles tendon-related disorders were not assessed which could have provided insight into the misuse of terms. In the literature study, we included a selection of eight foot and ankle journals, which caused selection bias.
Uniform terminology provides the ability to communicate with an universal language in daily practice amongst clinicians and researchers and will lead to the best available scientific-based treatment in clinical practice.
Acknowledgements
Ankleplatform Study Collaborative – Science of Variation Group:
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