Chronic Achilles Pain

Achilles TendinopathyInsertional Achilles Tendinopathy is a degeneration of the fibers of the Achilles tendon at its insertional point into the heel bone. It is often associated with inflammation of a bursa or tendon sheath in the same area. The Achilles tendon is the largest tendon in the body.

This condition is a degeneration of the tendon primarily caused by overuse through repetitive energy storage and release with excessive compression. This often leads to a sudden injury or, in a worst case scenario, a rupture of the Achilles tendon. In both situations, a lack of flexibility or a stiff Achilles tendon can increase the risk of these injuries. This often results in moderate to severe pain.

Several studies have shown ESWT to be an effective treatment for insertional Achilles tendinopathy. One study used the Victorian Institute of Sport Assessment – Achilles Score (VISA-A Score) to measure the improvement in patients treated with ESWT. After 4 months, the average VISA-A Score raised to 79.4 from a baseline of 53.2. The Likert scale was also used, and 64% of the patients treated with ESWT rated as Completely Recovered or Much Improved (compared to only 28% who were treated with the traditional eccentric loading protocol). Pain and Tenderness were also measured on a 0-10 scale. After 4 months, the average pain score dropped to 3.0/10 from a pre-treatment baseline of 7.0/10. After 4 months, the average tenderness score dropped to 2.4/10 from a pre-treatment baseline of 6.5/10. Rompe JD, Furia J, Maffulli N. Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg – Am. 2008;90(1):52–61. doi: 10.2106/JBJS.F.01494.

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