[Conservative treatment of Achilles tendinopathy]

Hind foot tendinopathies mainly involve the Achilles tendon. Color and Power-Doppler ultrasound visualizes pathological neovessels in painful tendons, which are associated with pain mediating nerve fibres. These neovessels are characterized by an increased capillary blood flow at the point of pain. Painful eccentric training can significantly reduce pain and improve function in Achilles tendinopathy (evidence level Ib). Shock wave therapy in combination with eccentric training is superior to eccentric training alone (evidence level Ib). Long-term results suggest a collagen induction and reduced pain following topical application of glyceryl trinitrate (NO) (evidence level Ib). Color and Power-Doppler-guided sclerosing therapy using polidocanol reduces pain, improves function and may lead to tendon remodeling (evidence level Ib). Pain-restricted sport up to a visual analogue scale (VAS) score 5/10 during therapy is recommended (evidence level Ib). Cryotherapy sessions of 3-times 10 min of reduce pain and capillary blood flow (evidence level Ib). The role of proprioceptive training in tendinopathy has to be determined in future trials (evidence level II). Anecdotical treatment of hindfoot tendinopathies has been replaced by evidence-based recommendations.