Abstract
The chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.
Highlights
Chronic painful mid-portion Achilles tendinopathy is a relatively common condition among recreational and elite athletes, but it is seen in non-active individuals
Intratendinous revision via tenotomy followed by 4-6 months of rehabilitation has been the most commonly used procedure worldwide
To achieve good clinical results after applying painful heavy loading on a chronic painful Achilles tendon was completely opposite to previous thinking around treatments of chronic painful tendons, and the good clinical results[4] led to research into the pain mechanisms involved in chronic painful mid‐portion Achilles tendinopathy
Summary
Chronic painful mid-portion Achilles tendinopathy is a relatively common condition among recreational and elite athletes, but it is seen in non-active individuals. Intratendinous revision via tenotomy followed by 4-6 months of rehabilitation has been the most commonly used procedure worldwide. The purpose of this clinical commentary is to show how the results of research on the basic science for this condition has resulted in a completely new treatment strategy with major advantages for the patients. In the 1990s, the Sports Medicine Unit in Umeå, Sweden, as in most other countries, used intratendinous revision surgery to treat patients with chronic painful mid-portion Achilles tendinopathy. To achieve good clinical results after applying painful heavy loading on a chronic painful Achilles tendon was completely opposite to previous thinking around treatments of chronic painful tendons, and the good clinical results[4] led to research into the pain mechanisms involved in chronic painful mid‐portion Achilles tendinopathy
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