Mid-portion Achilles tendinopathy--current options for treatment

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation Science

Background:

• Achilles tendinopathy affects both athletes and sedentary individuals, often linked to mechanical loading.
• Repetitive mechanical loading causes a non-inflammatory pathology where microtrauma overwhelms healing.
• Current management is primarily conservative, with many options lacking rigorous testing.

Purpose of the Study:

• To review current management options for mid-body Achilles tendinopathy.
• To focus on eccentric training and shock wave therapy as key non-operative treatments.
• To discuss the role and limitations of surgical intervention for refractory cases.

Main Methods:

• Literature review focusing on eccentric training and shock wave therapy for Achilles tendinopathy.
• Analysis of conservative and surgical management strategies.
• Evaluation of evidence for treatment efficacy and complications.

Main Results:

• Eccentric training and shock wave therapy are primary non-operative interventions.
• Surgical intervention may be effective for persistent cases but carries risks and may not fully resolve symptoms.
• Optimal loading conditions causing tendinopathy remain poorly defined.

Conclusions:

• Further research is required to establish optimal non-operative management strategies.
• Additional studies are needed to define the best surgical approaches for recalcitrant Achilles tendinopathy.
• A clearer understanding of causative mechanical factors is necessary.