Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid injections in a clinical setting

Abstract

In published efficacy studies on Achilles tendinopathy (AT) exercise alone results in improvement in 60-90% of the cases. However, this high success rate cannot be expected in usual clinical practice. We prospectively investigated the effectiveness of a treatment regimen consisting of home-based exercises (concentric, eccentric, and stretching) and optional glucocorticosteroid (GCS) injections in patients with (AT) in a usual clinical setting. Patients unable to commence or progress in exercise were offered GCS, hypothesizing that the GCS would facilitate exercise. Ninety-three consecutive patients with AT referred to two outpatient rheumatology clinics were registered, and seen at five visits over a 6-month period. Exercises seemed to have a slow, but long-lasting effect with GCS having a dramatic short-term effect on symptoms. Twenty-six percent of the patients could proceed with training alone, the remainder received one to three supplementary GCS. There were significant improvements on all outcome variables over time (P ≤ 0.001). At follow-up, 42 had no more symptoms, 29 good result, 16 slightly improved, 4 unchanged, and 2 slightly worse. Overall, 94% of the patients had improved, and we thus recommend the use of GCS injections in AT patients if training alone does not lead to improvement.

Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: A test‐retest intra‐ and intertester study

“…US of tendons and other soft tissues involves descriptions of thickness, hypoechogenity, hyperechogenity, and increased blood flow on power Doppler imaging. In our study, we have focused only on the measurement of the thickness of the selected tissues because increased thickness is the most commonly used parameter for diagnosis and outcome measurement in patients with plantar fasciitis and Achilles tendinopathy …”

“…In our study, we have focused only on the measurement of the thickness of the selected tissues because increased thickness is the most commonly used parameter for diagnosis and outcome measurement in patients with plantar fasciitis and Achilles tendinopathy. 9,13,14,21 Reliability studies most frequently enroll healthy volunteers because it is more conven-ient. 19,20,22,23 However, these data may not necessarily apply to patients in whom tissue echogenicity may be altered, which is why the current study is an important addition to the available literature.…”

“…8 In the former two, US is used to measure thickness as a diagnostic criteria 9,10 and as an outcome parameter. [11][12][13][14] Heel pad thickness has been shown to correlate with plantar fascia thickness and pain duration, 3 but others have been unable to demonstrate a difference between symptomatic and nonsymptomatic heels. 15 However, these measurements are operator dependent, and there is generally a lack of reliability and validity tests.…”

Trigger point dry needling, manual therapy and exercise versus manual therapy and exercise for the management of Achilles tendinopathy: a feasibility study

“…5 A large number of non-surgical treatment options exist to manage the pain and restore normal activity tolerance 8,15,51,52 ; however, research is largely inconclusive on the effectiveness. 15,53,54 Physical therapy is one treatment option with interventions including eccentric exercise and modalities. 15 However, there is limited evidence to support the effectiveness with these interventions for Achilles tendinopathy.…”

“…13,14 The slow response has led to the implementation of other interventions for managing Achilles tendinopathy. The combined effects of eccentric training with corticosteroid injections, 54 extracorporeal shockwave therapy 76,100 and tendon needling 56,101 have been reported to be more effective than eccentric training alone.…”