Achilles tendinopathy — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 86 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting Achilles tendinopathy or death from Achilles tendinopathy with the circumstances of a person's relevant service:

1. (1)
   running or jogging an average of at least 30 kilometres per week for the 4 weeks before clinical onset or clinical worsening;
2. (2)
   undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side for: (a) a minimum intensity of 5 METS; and (b) for at least 4 hours per week; and (c) for at least the 4 weeks before clinical onset or clinical worsening;

   Note: Examples of weight bearing exercise involving repeated activity of the ankle joint at a minimum intensity of 5 METS include marching, playing basketball, football, volleyball, and track and field (especially those activities that involve jumping).

   Note: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening.

3. (3)
   increasing the frequency, duration or intensity of activity involving the ankle joint on the affected side: (a) by at least 100 percent; and (b) to a minimum intensity of 5 METs; and (c) for at least 2 hours per day; within the 1 week before the clinical onset or clinical worsening; with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening;

   Note: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated.

4. (4)
   having one or more of the following conditions involving the affected lower limb at the time of clinical onset or clinical worsening: (a) pes planus; (b) pes cavus; (c) decreased ankle or forefoot flexibility; (d) forefoot varus; (e) lateral ankle joint instability;
5. (5)
   having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: (a) ankylosing spondylitis; (b) Behcet syndrome; (c) enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease); (d) gout; (e) pseudogout (calcium pyrophosphate dihydrate) or crystal-induced arthropathy from the deposition of calcium hydroxyapatite or calcium oxalate; (f) psoriatic arthropathy (g) reactive arthritis; (h) rheumatoid arthritis; or (i) undifferentiated spondyloarthropathy;
6. (6)
   having chronic renal failure within the 10 years before clinical onset or clinical worsening as indicated by: (a) a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or (b) undergoing chronic dialysis for renal failure;
7. (7)
   being treated with a fluoroquinolone antibiotic within the 30 days before clinical onset or clinical worsening;

   Note: Examples of fluoroquinolone antibiotics include ciprofloxacin, moxifloxacin, norfloxacin and ofloxacin.

8. (8)
   being treated with a glucocorticoid drug as specified before clinical onset or clinical worsening;

   Note: being treated with a glucocorticoid drug as specified is defined in the Schedule 1 - Dictionary.

9. (9)
   having a glucocorticoid injection into the Achilles tendon, in the region of the Achilles tendon or in the retrocalcaneal bursa, before the rupture of the Achilles tendon;

   Note: rupture of the Achilles tendon can constitute clinical onset or clinical worsening of Achilles tendinopathy.

10. (10)
    being treated with an aromatase inhibitor for at least 4 weeks within the 1 year before clinical onset or clinical worsening;

    Note: Examples of aromatase inhibitors include anastrozole, exemestane and letrozole.

11. (11)
    having a Body Mass Index (BMI) of 30 or greater at the time of clinical onset or clinical worsening;

    Note: BMI is defined in the Schedule 1 - Dictionary.

12. (12)
    having diabetes mellitus at the time of clinical onset or clinical worsening;
13. (13)
    inability to obtain appropriate clinical management for Achilles tendinopathy before clinical worsening;