Abstract
Tendon loading dictates rehabilitation outcomes in Achilles tendinopathy but is difficult to track in the real world. In this study, we used instrumented insole sensors to monitor Achilles tendon load for two weeks in fifteen individuals with Achilles tendinopathy, who also completed assessments of their plantar flexor strength, dynamic function, and survey-based outcomes. We used insole data to estimate two types of cumulative Achilles tendon load: overall (≥ 0.3×body weight) and high-level load (≥ 3×body weight). We determined Pearson correlations between (1) overall and high-level tendon loads, (2) plantar flexor moment, power, work, (3) heel raise height, repetitions, countermovement jump height, and (4) self-reported symptoms and activity. Overall cumulative tendon load moderately correlated to isometric plantar flexor moment (r = 0.543) and weakly to isokinetic and dynamic functions (0.128–0.413). Cumulative high-level tendon load strongly correlated to heel raise height (0.687) and fast isokinetic moment (0.625), and moderately to other functional measures (0.470–0.592). Symptoms weakly correlated to overall (0.392) and moderately to high-level load (0.436). Self-reported activity weakly correlated to overall (0.297) and strongly to high-level load (0.617). Stronger associations with the high-level Achilles tendon load than the overall load suggest that clinical function assessments provide insight into the real-world performance of high-loading activities. In contrast, the disconnect between overall tendon loading and plantar flexor function may explain the variability in recovery outcomes. Self-reported activity and standard heel raises represent high-level tendon load well, yet they do not always suggest functional deficit. Sensor-monitored tendon load shows promise as a new biomarker for real-world plantar flexor function in Achilles tendinopathy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-026-40438-1.