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. 2025 Jan 13;14(2):473.
doi: 10.3390/jcm14020473.

Do Anxiety, Depression, Fear of Movement and Fear of Achilles Rupture Correlate with Achilles Tendinopathy Pain, Symptoms or Physical Function?

George White  1 , Fletcher Bright  1 , Ebonie K Rio  2   3   4 , Ruth L Chimenti  5 , Myles C Murphy  1   6
Affiliations

Do Anxiety, Depression, Fear of Movement and Fear of Achilles Rupture Correlate with Achilles Tendinopathy Pain, Symptoms or Physical Function?

George White et al. J Clin Med. .

Abstract

Objectives: To determine if psychological factors, such as anxiety, depression, fear of movement and fear of rupture are associated with increased tendon-related disability, quantified by the Tendinopathy Severity Assessment-Achilles (TENDINS-A). Design: Cross-sectional. Setting: Online Qualtrics survey. Participants: Sixty-eight participants (54% female) with Achilles tendinopathy and a mean (standard deviation) age of 40.1 (12.6) years. Main Outcome Measures: The TENDINS-A (including subscales of pain; symptoms such as stiffness; physical function), Patient Health Questionnaire-9, General Anxiety Disorder-7, Tampa Scale for Kinesiophobia and fear of tendon rupture. Associations were evaluated using generalised linear models (adjusting for age and sex), with significance accepted when p < 0.05. Results: Anxiety symptoms were positively associated with Achilles pain (p = 0.035), symptoms (p = 0.045) and physical function (p = 0.019). Depressive symptoms were negatively associated with symptoms (p = 0.045) but not pain (p = 0.078) or physical function (p = 0.429). Fear of movement was not associated with pain (p = 0.479), symptoms (p = 0.915) or physical function (p = 0.064). Fear of rupture was associated with pain (p = 0.042), but not symptoms (p = 0.797) or physical function (p = 0.509). Conclusions: Our research demonstrated anxiety symptoms and fear of rupture, not fear of movement or depressive symptoms, are positively associated with the severity of tendon-related disability. Therefore, clinicians should include an assessment anxiety symptoms and fear of rupture in their practice.

Keywords: Achilles; TENDINS-A; psychological factors; tendinopathy; tendon.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
Pain map. (A) Insertional Achilles, (B) Peritendon, (C) Plantaris, (D) Midportion Achilles, (E) Medial Ankle Tendons, (F) Sural Nerve, (G) Diffuse Superficial Bursa, (H) Triceps Surae Myotendinous Junction.
See this image and copyright information in PMC

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