Chronic achilles tendinopathy: treatment with extracorporeal shock waves

Abstract

Background: Chronic Achilles tendinopathy is a common disabling condition affecting in particular, active middle aged sportsmen. The aim of this study is to evaluate the long-term clinical results and complications of extra-corporeal shock wave therapy (ESWT) in the treatment of chronic Achilles tendinopathy. Methods: Sixteen affected tendons in 15 patients who had recalcitrant non-insertional Achilles tendinopathy and had been listed for surgery were treated with ESWT. Eleven of the patients were involved in active sports. In each case the clinical diagnosis was confirmed on ultrasonography. The ankle hindfoot scale (AHS) and the Victorian Institute of Sport Assessment-Achilles (VISA-A) score were performed before therapy and again at the most recent follow-up. The mean follow-up period was 20.7 months. Results: ESWT was associated with a significant improvement in the AHS (from 57.2±15.2 to 87.2±11.4, p<0.001) and VISA-A score (from 46.6±11.3 to 75.9±19.1, p<0.001). The results were excellent in three cases and good in 11 cases. In two patients there was no improvement and the condition remained the same. It was also shown that patients with low AHS scores before the therapy benefited the most. There were no complications but six patients expressed their dissatisfaction about the pain felt during the therapy. Conclusion: ESWT is effective as a conservative therapeutic tool for chronic Achilles tendinopathy.