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Achilles tendinopathy - which treatment is most effective?

Achilles tendinopathy is an overload injury, and can affect as many as 50% of the active population who run or play team sports. Typically, the injury can occur where the tendon inserts into heel, or at the midportion. Patients can expect a recovery time from between 3 and 12 months. Chronic symptoms can persist in around 25% of cases, 10 years after treatment begins. This can lead to impairment in quality of life and physical activity.

Principal treatment options include wait-and-see, exercise therapy, injections, shockwave therapy, orthosis, medication and surgery. For midportion Achilles tendinopathy, active treatments are seen to be superior to wait-and-see approaches at 3 months post initiation of treatment. Calf-muscle exercise therapy is easy to prescribe, is widely available, and is regarded as safe and cheap. As a result, clinicians should use exercise therapy as a primary approach, and should this fail, consider alternative treatments. Many patients will often use a number of treatments due to the slow progress made, and will often be unsure as to what effect each intervention has had on their recovery.

Educating patients about the injury, projected recovery times, and best practice, is crucial for effective recovery. Patients will become despondent if they do not see the results they would normally expect from a soft tissue injury, so clinicians should be their guide to their return to sport.


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