Conservative Care For Mid-Portion Achilles Tendinopathy

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Author(s): 
Kent Sweeting, B.Hlth.Sc.(Pod)(Hons)
Platelet-rich plasma injection for chronic Achilles tendinopathy: A randomized controlled trial. JAMA 2010; 303(2):144-9.
48. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for chronic noninsertional Achilles tendinopathy. Am J Sports Med 2006; 34(5):733-40.
49. Rompe JD, Nafe B, Furia JP, et al. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achilles: A randomized controlled trial. Am J Sports Med 2007; 35(3):374-83.
50. Lakshmanan P, O’Doherty DP. Chronic Achilles tendinopathy: treatment with extracorporeal shock waves. Foot Ankle Surg 2004; 10:125-30.

















































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crstuartsays: November 14, 2010 at 11:40 am

Excellent explanation and recommendation on the technique of "no concentric contraction on the affected side."

I have a patient who has suffered with chronic post-static dyskinesia in the Achilles tendon mid-substance area for 2 years. He has slight discomfort before running, the pain subsides with running and then the pain returns about 1 hour after running.

X-rays show a large Os trigonum and MRI is negative for inflammatory changes around the OS, Achilles or FHL. Is it possible that this Os is just an incidental finding and that the focus should be on eccentric stretching? This large Os somewhat limits his ability to raise onto his toes and plantarflex his foot. Surgical excision of the Os may allow more plantarflextion but is it worth the risks of painful scar tissue formation, neuritis, etc.? Five weeks of physical therapy helped relieve the pain but within 3 weeks of easing back into a jogging routine, the insidious onset of pain returned.

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Anonymoussays: December 7, 2010 at 4:29 pm

Certainly, the patient history sounds like Achilles tendinopathy. Did the MRI or physical exam demonstrate thickening of the Achilles tendon? Is the Achilles tendon tender to palpate (see '"What to look for in the examination" section)? The os trigonum could be a red herring. Perhaps you could try the eccentric program +/- a corticosteroid injection around the os trigonum. Good luck!

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Trent Perringsays: May 1, 2011 at 4:26 am

Great work Kent!

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