Chronic mid-substance Achilles tendinopathy
-Definition: midsubstance Achilles tendinopathy with symptoms lasting longer than 6 weeks.
Treatment
-The preferred first-line treatment is an intense eccentric strengthening program of the gastrocnemius/soleus complex.
“In randomized, controlled trials, eccentric strengthening programs have provided 60%–90% improvement in pain and function.
To perform eccentric strengthening for Achilles tendinopathy the patient should stand on the ball of the injured foot with the calcaneal area of the foot over the edge of a stair step. The patient begins with a straight leg and the ankle in flexion. The ankle is then lowered to full dorsiflexion with the heel below the level of the step and then returned to flexion with the assistance of the uninjured leg.
Surgical techniques are a last resort for severe or recalcitrant cases, but these techniques have not been consistently successful and carry additional risk.”ABFM
“The term Achilles tendinopathy reflects the chronic, noninflammatory, degenerative nature of this disorder as opposed to the traditional term tendinitis. Eccentric strengthening programs of the gastrocnemius and soleus muscles have demonstrated 60%–90% improvement in pain and function and are considered the first-line treatment for chronic midsubstance Achilles tendinopathy. Oral NSAIDs and oral corticosteroids are ineffective, and local corticosteroid injection in or near a load-bearing tendon such as the Achilles tendon increases the risk of tendon rupture. Surgical tendinoplasty is inconsistently beneficial and carries added risk, and is not a first-line treatment.”
References
Childress MA, Beutler A: Management of chronic tendon injuries. Am Fam Physician 2013;87(7):486-490.