Chronic Achilles Tendinopathy in Runners: Relationship between Pain and Tendon Vascularity and Efficacy and Safety of the Radial Extracorporeal Shock Wave Therapy

Antonio Ammendolia

doi:10.4236/crcm.2015.46044

Abstract

Few studies report the possible correlation pain-paratendon microvascularity during the painful phase of the chronic Achilles tendinopathy and the efficacy of the radial shock wave therapy re-spect to other therapies. The aim of the present longitudinal, controlled study is to demonstrate the variation of the tendon micro vascularization in athletes affected by Achilles tendinopathy and the efficacy and safety of the radial extracorporeal shock wave therapy. Twelve elite runners with Achilles tendinopathy were compared with 12 healthy amateurs, both treated by radial extracorporeal shock wave therapy in 3 sessions (1/every 3 days). VAS scale was used for pain evaluation at one and six months after treatment and a Color and Power Doppler echography was performed to observe the paratendon microvascularity before the beginning of the treatment and at one and six months after. One month after the beginning of the treatment, it was observed a decrease of the hypervascularity in all 12 subjects with tendinopathy and no variation in the control group participants. Clinically, 80% of patients referred pain relief and they were able to return to sports activity. The decrease of the paratendon microvascularity confirms the correlation between the disappearance of the pain and the normalization of the vascularity in the athletes. Moreover, radial extracorporeal shock wave therapy consented a quickly pain relief and returned to the sport. These results confirmed the efficacy and safety of this physical therapy that it could be considered a good therapeutic choice in the treatment of the chronic Achilles tendinopathy.

Highlights

Achilles tendinopathy is a common cause of posterior heel pain and it’s often difficult to treat
The purpose of this study is to evaluate the correlation between increased paratendon microvascularity and pain and to determine the efficacy of radial extracorporeal shock wave therapy for the treatment of the Achilles tendinopathy in long distance runners, comparing with a control group
For all subjects of the group A, the echography at T0 demonstrated the presence of an area of hypoechogenicity in the mid portion of the Achilles tendon with an increase of the microvascularity (Figure 1)

Summary

Introduction

Achilles tendinopathy is a common cause of posterior heel pain and it’s often difficult to treat. This condition is more frequent in athletes, runners and jumpers, but it can affect non-athletes as well. The beginning and pathogenesis of the tendinopathy are often unknown, but intrinsic and extrinsic factors have been involved [1] [2]. Intrinsic factors include abnormal range of motion of the subtalar joints such as in hyperpronation syndrome or for a leg length discrepancy. Extrinsic factors for athletes include training errors with subsequent excessive mechanical overload. The literature reported the association between increased paratendon microvascularity and the symptomatic Achilles tendinopathy. Some studies based on the use of the Color Power Doppler sonography have demonstrated an increased vascular density in the Achilles paratenon that is clinically associated with chronic and insertional Achilles tendinopathy [9]-[13]

Objectives

Methods

Results

Discussion

Conclusion