Outcome of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy with and without Haglund’s Deformity

Abstract

Purpose. To compare the results of extracorporeal shock wave therapy (ESWT) for insertional Achilles tendinopathy (IAT) with or without Haglund's deformity. Methods. Between September 2014 and May 2015, all patients who underwent ESWT were retrospectively enrolled in this study. A total of 67 patients were available for follow-up and assigned into nondeformtiy group (n = 37) and deformtiy group (n = 30). Clinical outcomes were evaluated by VISA-A Score and 6-point Likert scale. Results. The VISA-A score increased in both groups, from 49.57 ± 9.98 at baseline to 83.86 ± 8.59 at 14.5 ± 7.2 months after treatment in nondeformity group (P < 0.001) and from 48.70 ± 9.38 at baseline to 67.78 ± 11.35 at 15.3 ± 6.7 months after treatment in deformity group (P < 0.001). However, there was a greater improvement in VISA-A Score for the nondeformity group compared with deformity group (P = 0.005). For the 6-point Likert scale, there were decreases from 3.92 ± 0.80 at baseline to 1.57 ± 0.73 at the follow-up time point in nondeformity group (P < 0.001) and from 4.0 ± 0.76 at baseline to 2.37 ± 1.03 at the follow-up time point in deformity group (P < 0.001). There was no significant difference in improvement of the 6-point Likert scale between both groups (P = 0.062). Conclusions. ESWT resulted in greater clinical outcomes in patients without Haglund's deformity compared with patients with Haglund's deformity.

Achilles insertional tendinopathy: state of the art

“…The presence of Haglund’s deformity negatively affects the outcome of ESWT in patients with IAT 31. Notarnicola et al reported the outcomes of the use of ESWT compared with High Energy Laser Therapy (CHELT), both followed by a protocol of eccentric exercises and stretching.…”

Combined ESWT and RSW Therapy for Achilles Tendinopathy: A Prospective Study

“…For plantar fasciitis, ESWT has shown to be more effective than RSW (12). We reviewed several studies on SW for Achilles tendinopathy (table I A-D); seven previous studies (13,14,15,16,17,18,19) showed significant improvement in patients with Achilles tendinopathy treated with RSW. Five of those seven studies (13,14,15,16,19) had control groups that did not receive shockwave treatment.…”

“…This was not considered statistically significant, given the sample size. (18). There was no control group.…”

Extracorporeal Shock Wave Therapy for Achilles Tendinopathy

“…A four-month duration was selected as the eligibility criterion by Costa et al [23], while others considered patients who had been suffering for six months [6,7,17,19,20,22,28,29,[34][35][36]. Santamato et al [33] and Lynen et al [27] used shorter eligibility periods, i.e., 4 and 6 weeks, respectively, while several authors did not specify the duration of Achilles tendinopathy symptoms at all [26,32,38]. Regarding acute tendinopathy, Ciccotti et al [41] emphasized that although patients describe the pain as acute, the degenerative character of the dysfunction indicates that the tendon's adaptation to tensile overloading has been impaired long before symptom occurrence.…”