Treatment of Chronic Achilles Tendinopathies

Abstract

The overuse type of injury to the Achilles tendon is the painful type of injury that occurs when the body's reparative capability is exceeded by repetitive microtrauma [ 1 ]. The injury can be in an acute or chronic phase. The exact time criteria that are used to classify the injury as acute or chronic are arbitrary. In the literature, defi nitions for the injury to be chronic range from 4 weeks to 3 months or pain on and off for more than 6 months [ 2 -5 ]. The acute phase injury consists of partial ruptures, bursitis or paratendonitis. The chronic phase injury can be divided into distal Achilles tendinopathy and midportion Achilles tendinopathy depending on the location of the pain.In 163 patients with chronic Achilles tendinopathy, surgical and histopathological fi ndings showed that 90 % had degenerative changes, socalled tendinosis [ 6 ]. On the other hand, degenerative changes were also found in 20 % of non-symptomatic tendons. Another fi nding was Treatment of Chronic Achilles TendinopathiesJon Karlsson , Annelie Brorsson , and Karin Grävare Silbernagel AbstractAchilles tendinopathy is a common and often diffi cult to treat problem. The best known and best researched treatment is rehabilitation exercises either concentric or concentric-eccentric exercises. To experience a favourable outcome from exercise, the exercises are allowed to cause pain. Therefore, the use of a pain-monitoring model together with a training log help the patient and the clinician to balance between overloading and loading enough to achieve a positive response to the exercises. The exercise programme needs to continue for at least 12 weeks, and often it needs to be continued for up to a year. It might also be benefi cial to combine the exercise treatment with other treatments, such as shockwave therapy, laser therapy and the use of orthotics. Surgery is considered as the last option. Patients with insertional Achilles tendinopathy are more likely to need surgery compared with patients with mid-portion Achilles tendinopathy