Achilles tendinopathy

Abstract

1. Clinicians and therapist should unify their terminology and use the term tendinopathy to clinically describe tendon conditions. 2. Correct exercise and training technique is crucial for the prevention of Achilles tendinopathy. 3. At early stages, Achilles tendinopathy could be successfully treated nonoperatively in 2 to 3 months, while long standing chronic tendinopathy is more difficult to treat and may require 4 to 6 months to recover. 4. Nonoperative treatment relies primarily on appropriate tendon loading. This can be achieved by activity modification and by biomechanical correction. Relative rest, heel lift, cryotherapy, deep friction massage, and electrotherapy are all used with variable success rate.The benefit of steroid injections has not been consistently documented. 5. Imaging is recommended only when the diagnosis is unclear, as it has not been shown to be a useful guide to management or prognosis.A focal hypoechoic region on US, or a region of high signal on MR do not constitutes, per se, an indication for surgery. 6. Surgery is recommended if nonoperative treatment for 3 to 6 months is unsuccessful. 7. The objective of surgery is to improve local circulation and stimulate natural healing process.The procedure involves removing adhesions, inflamed and degenerated areas with tendon decompression through fasciotomy and longitudinal tenotomies. 8. It takes between 6 and 12 months to return to full competitive sport after successful Achilles tendon surgery. However, full recovery to prior levels of performance is not predictable in any one individual and are dependent upon variables of repair and rehabilitation. Therefore, expectations should be cautiously optimistic.