Skip to main content
SpringerLink
Log in

Treatment of Chronic Achilles Tendinopathies

  • Chapter
  • First Online:
European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 14))

Abstract

Achilles tendinopathy is a common and often difficult 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 beneficial 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

© EFORT 2014

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med. 1992;11:533–78.

    CAS  PubMed  Google Scholar 

  2. el Hawary R, Stanish WD, Curwin SL. Rehabilitation of tendon injuries in sport. Sports Med. 1997;24:347–58.

    Article  PubMed  Google Scholar 

  3. Angermann P, Hovgaard D. Chronic Achilles tendinopathy in athletic individuals: results of nonsurgical treatment. Foot Ankle Int. 1999;20:304–6.

    Article  CAS  PubMed  Google Scholar 

  4. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9:42–7.

    Article  CAS  PubMed  Google Scholar 

  5. Roos EM, Engström M, Lagerquist A, et al. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy – a randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004;14:286–95.

    Article  PubMed  Google Scholar 

  6. Åström M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Relat Res. 1995;316:151–64.

    Google Scholar 

  7. Józsa L, Kannus P. Human tendons. Anatomy, physiology and pathology. Champaign. Leeds: Human Kinetics; 1997.

    Google Scholar 

  8. Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22:675–92.

    Article  PubMed  Google Scholar 

  9. Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22:727–41.

    Article  PubMed  Google Scholar 

  10. Kader D, Saxena A, Movin T, et al. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. 2002;36:239–49.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Paavola M, Kannus P, Järvinen TA, et al. Achilles tendinopathy. J Bone Joint Surg Am. 2002;84-A:2062–76.

    PubMed  Google Scholar 

  12. Järvinen M. Epidemiology of tendon injuries in sports. Clin Sports Med. 1992;11:493–504.

    PubMed  Google Scholar 

  13. Jarvinen TA, Kannus P, Maffulli N, et al. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10:255–66.

    Article  PubMed  Google Scholar 

  14. Kvist M. Achilles tendon injuries in athletes. Sports Med. 1994;18:173–201.

    Article  CAS  PubMed  Google Scholar 

  15. Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol. 1991;80:188–201.

    CAS  PubMed  Google Scholar 

  16. Vora AM, Myerson MS, Oliva F, et al. Tendinopathy of the main body of the Achilles tendon. Foot Ankle Clin. 2005;10:293–308.

    Article  PubMed  Google Scholar 

  17. Sandmeier R, Renström PA. Diagnosis and treatment of chronic tendon disorders in sports. Scand J Med Sci Sports. 1997;7:96–106.

    Article  CAS  PubMed  Google Scholar 

  18. Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, et al. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. J Foot Ankle Res. 2012;5:15.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med. 2009;19:54–64.

    Article  PubMed  Google Scholar 

  20. Alfredson H, Pietilä T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26:360–6.

    CAS  PubMed  Google Scholar 

  21. Silbernagel KG, Thomee R, Eriksson BI, et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35:897–906.

    Article  PubMed  Google Scholar 

  22. van der Plas A, de Jonge S, de Vos RJ, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46:214–8.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Silbernagel KG, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up. Am J Sports Med. 2011;39:607–13.

    Article  PubMed  Google Scholar 

  24. Silbernagel KG, Gustavsson A, Thomee R, et al. Evaluation of lower leg function in patients with Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2006;14:1207–17.

    Article  PubMed  Google Scholar 

  25. Thomeé R. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Phys Ther. 1997;77:1690–703.

    PubMed  Google Scholar 

  26. Silbernagel KG, Thomeé R, Thomeé P, et al. Eccentric overload training for patients with chronic Achilles tendon pain–a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports. 2001;11:197–206.

    Article  CAS  PubMed  Google Scholar 

  27. Khan KM, Cook JL, Bonar F, et al. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999;27:393–408.

    Article  CAS  PubMed  Google Scholar 

  28. Alfredson H, Thorsen K, Lorentzon R. In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain. Knee Surg Sports Traumatol Arthrosc. 1999;7:378–81.

    Article  CAS  PubMed  Google Scholar 

  29. Åström M, Westlin N. No effect of piroxicam on Achilles tendinopathy. A randomized study of 70 patients. Acta Orthop Scand. 1992;63:631–4.

    PubMed  Google Scholar 

  30. Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc. 1998;30:1183–90.

    Article  CAS  PubMed  Google Scholar 

  31. Kleinman M, Gross AE. Achilles tendon rupture following steroid injection. Report of three cases. J Bone Joint Surg Am. 1983;65:1345–7.

    CAS  PubMed  Google Scholar 

  32. Gill SS, Gelbke MK, Mattson SL, et al. Fluoroscopically guided low-volume peritendinous corticosteroid injection for Achilles tendinopathy. A safety study. J Bone Joint Surg Am. 2004;86-A:802–6.

    PubMed  Google Scholar 

  33. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376:1751–67.

    Article  CAS  PubMed  Google Scholar 

  34. Yuan J, Murrell GA, Wei AQ, et al. Addition of nitric oxide via nitroflurbiprofen enhances the material properties of early healing of young rat Achilles tendons. Inflamm Res. 2003;52:230–7.

    Article  CAS  PubMed  Google Scholar 

  35. Paoloni JA, Appleyard RC, Nelson J, et al. Topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004;86-A:916–22.

    PubMed  Google Scholar 

  36. Paoloni JA, Murrell GA. Three-year followup study of topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int. 2007;28:1064–8.

    Article  PubMed  Google Scholar 

  37. Rompe JD, Nafe B, Furia JP, et al. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 2007;35:374–83.

    Article  PubMed  Google Scholar 

  38. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37:463–70.

    Article  PubMed  Google Scholar 

  39. Furia JP, Rompe JD, Cacchio A, et al. A single application of low-energy radial extracorporeal shock wave therapy is effective for the management of chronic patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2013;21:346–50.

    Article  PubMed  Google Scholar 

  40. Haake M, Konig IR, Decker T, et al. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial. J Bone Joint Surg Am. 2002;84-A:1982–91.

    CAS  PubMed  Google Scholar 

  41. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med. 2006;34:733–40.

    Article  PubMed  Google Scholar 

  42. Bjordal JM, Lopes-Martins RA, Iversen VV. A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med. 2006;40:76–80; discussion 76–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Salate AC, Barbosa G, Gaspar P, et al. Effect of In-Ga-Al-P diode laser irradiation on angiogenesis in partial ruptures of Achilles tendon in rats. Photomed Laser Surg. 2005;23:470–5.

    Article  PubMed  Google Scholar 

  44. Reddy GK, Stehno-Bittel L, Enwemeka CS. Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers Surg Med. 1998;22:281–7.

    Article  CAS  PubMed  Google Scholar 

  45. Tumilty S, Munn J, McDonough S, et al. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg. 2010;28:3–16.

    Article  PubMed  Google Scholar 

  46. Tumilty S, Munn J, Abbott JH, et al. Laser therapy in the treatment of Achilles tendinopathy: a pilot study. Photomed Laser Surg. [serial on the Internet]. 2008;26(1). Available from: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/818/CN-00629818/frame.html.

  47. Carcia CR, Martin RL, Houck J, et al. Achilles pain, stiffness, and muscle power deficits: Achilles tendinitis. J Orthop Sports Phys Ther. 2010;40:A1–26.

    Article  PubMed  Google Scholar 

  48. Enwemeka CS. The effects of therapeutic ultrasound on tendon healing. A biomechanical study. Am J Phys Med Rehabil. 1989;68:283–7.

    Article  CAS  PubMed  Google Scholar 

  49. Chester R, Costa ML, Shepstone L, et al. Eccentric calf muscle training compared with therapeutic ultrasound for chronic Achilles tendon pain – a pilot study. Man Ther. [serial on the Internet]. 2008;13(6). Available from: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/247/CN-00668247/frame.html.

  50. Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys Ther. 2001;81:1339–50.

    CAS  PubMed  Google Scholar 

  51. Lowdon A, Bader DL, Mowat AG. The effect of heel pads on the treatment of Achilles tendinitis: a double blind trial. Am J Sports Med. 1984;12:431–5.

    Article  CAS  PubMed  Google Scholar 

  52. Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. 2005;72:811–8.

    PubMed  Google Scholar 

  53. Alfredson H, Öhberg L. Neovascularisation in chronic painful patellar tendinosis–promising results after sclerosing neovessels outside the tendon challenge the need for surgery. Knee Surg Sports Traumatol Arthrosc. 2005;13:74–80.

    Article  PubMed  Google Scholar 

  54. Leach RE, Schepsis AA, Takai H. Long-term results of surgical management of Achilles tendinitis in runners. Clin Orthop Relat Res. 1992;282:206–12.

    Google Scholar 

  55. Nelen G, Martens M, Burssens A. Surgical treatment of chronic Achilles tendinitis. Am J Sports Med. 1989;17:754–9.

    Article  CAS  PubMed  Google Scholar 

  56. Paavola M, Kannus P, Orava S, et al. Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow up study. Br J Sports Med. 2002;36:178–82.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Schepsis AA, Wagner C, Leach RE. Surgical management of Achilles tendon overuse injuries. A long-term follow-up study. Am J Sports Med. 1994;22:611–9.

    Article  CAS  PubMed  Google Scholar 

  58. Tallon C, Coleman BD, Khan KM, et al. Outcome of surgery for chronic Achilles tendinopathy. A critical review. Am J Sports Med. 2001;29:315–20.

    CAS  PubMed  Google Scholar 

  59. Paavola M, Orava S, Leppilahti J, et al. Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med. 2000;28:77–82.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

    Jon Karlsson MD, PhD & Annelie Brorsson PT

  2. Department of Physical Therapy, Samson College of Health Professions, University of the Sciences, 600 S. 43rd Street, Philadelphia, PA, 19104, USA

    Karin Grävare Silbernagel PT, ATC, PhD

Authors
  1. Jon Karlsson MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annelie Brorsson PT
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karin Grävare Silbernagel PT, ATC, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jon Karlsson MD, PhD .

Editor information

Editors and Affiliations

  1. Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, United Kingdom

    George Bentley

Rights and permissions

Reprints and permissions

Copyright information

© 2014 EFORT

About this chapter

Cite this chapter

Karlsson, J., Brorsson, A., Silbernagel, K.G. (2014). Treatment of Chronic Achilles Tendinopathies. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 14. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54030-1_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54030-1_16

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54029-5

  • Online ISBN: 978-3-642-54030-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation