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Updated: Aug 5, 2026
A Treatment Protocol for Achilles Tendinopathy with Extracorporeal Shockwave Therapy
Published on: August 2, 2024
Conservative Treatment Including Focused Extracorporeal Shockwave Therapy as a First-Line Treatment for Isolated
L Alejandro Culebras Almeida1, Adrien J-P Schwitzguebel2
1Centre de Médecine du Sport et de l'Exercice, Swiss Olympic Medical Center, Hirslanden Clinique la Colline, 1206 Geneva, Switzerland.
Introduction:
Isolated peroneus longus (PL) tendon tears are rare injuries and an often-overlooked cause of chronic lateral ankle pain. Evidence regarding optimal conservative management, especially in elite athletes, remains limited. Focused extracorporeal shockwave therapy (F-ESWT) has shown promising results in tendinopathies, yet its application in acute tendon tears is poorly documented.
Methods:
We present the case of a professional football player in his late twenties who sustained an isolated longitudinal PL tear. The player underwent a combined conservative protocol including F-ESWT, physiotherapy, and custom orthotics. Pain (Visual Analog Scale, VAS) and function (AOFAS Ankle-Hindfoot Score) were assessed at baseline, three months, and in an 18-month follow-up. MRI scans were obtained at diagnosis and after six weeks to evaluate tendon healing.
Results:
The conservative treatment protocol, including eight sessions of ultrasound-guided F-ESWT (2500-4000 impulses per session, 50-550 µJ/mm2) led to marked pain relief and functional improvement. VAS decreased from 7/10 to 1/10, while AOFAS improved from 57 to 95 points, maintained at 18 months. MRI after six weeks of treatment demonstrated decreased intratendinous hyperintensity, reduced lesion length, and re-establishment of normal tendon architecture. The player returned to training after eight weeks and full competition after 12 weeks, remaining asymptomatic thereafter.
Conclusions:
A multimodal treatment consisting of F-ESWT, physiotherapy with progressive loading and orthotic correction resulted in rapid and durable healing of an isolated PL tear in a professional athlete. This case supports the potential role of a multimodal conservative treatment strategy including F-ESWT as a first-line, non-invasive option for acute peroneal tendon tears.
