Achilles insertional tendinopathy: state of the art

2018 ◽  
Vol 4 (1) ◽  
pp. 48-57 ◽  
Author(s):  
Nicola Maffulli ◽  
Amol Saxena ◽  
Emilio Wagner ◽  
Guglielmo Torre
Keyword(s):  
Soft Tissue ◽  
Achilles Tendinopathy ◽  
Outcome Evaluation ◽  
Tissue Imaging ◽  
Management Options ◽  
Shockwave Therapy ◽  
Insertional Tendinopathy ◽  
Geographical Regions ◽  
Extensive Debridement ◽  
Tendon Pathology

Achilles tendon pathology is a most common musculoskeletal condition in active individuals and athletes. Almost 6% of the general population will suffer from such ailment in their lifetime. Insertional Achilles tendinopathy (IAT) differs in its physiopathology, clinical features and treatment from midportion tendinopathy. The literature has mainly focused on assessment, outcome evaluation and treatment of IAT, although differences in management according to different geographical regions have not been addressed. The principles of clinical evaluation and imaging assessment of IAT are well established, with a major role of clinical assessment and soft tissue imaging, including ultrasonography and MRI. Conservative management options include eccentric training, extracorporeal shockwave therapy and prolotherapy, or a combination of these modalities. Recently, regenerative medicine has been more widely used, with at times dubious results. Surgery is advocated where conservative treatment is not beneficial within 6 months. Surgery includes more or less extensive debridement of peritendinous bony and soft tissue structures. To improve our knowledge about IAT, more evidence should be provided concerning innovative treatments, especially considering growth factors injections and percutaneous surgery.

scholarly journals Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Reem EL-Mallah ◽  
Enas A. Elattar
Keyword(s):  
Treatment Options ◽  
Visual Analogue Score ◽  
Achilles Tendinopathy ◽  
Extracorporeal Shockwave Therapy ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Tendon Thickness ◽  
Vas Scores ◽  
Tendon Pathology

Abstract Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

Extracorporeal Shockwave Therapy for the Treatment of Achilles Tendinopathies

2008 ◽  
Vol 98 (6) ◽  
pp. 466-468 ◽  
Author(s):  
Robert Fridman ◽  
Jarrett D. Cain ◽  
Lowell Weil ◽  
Lowell Weil
Keyword(s):  
Plantar Fascia ◽  
Achilles Tendinopathy ◽  
Extracorporeal Shockwave Therapy ◽  
Conservative Care ◽  
Extracorporeal Shockwave ◽  
Shockwave Therapy ◽  
Visual Analog Pain Score ◽  
The Mean ◽  
Tendon Pathology

Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders. Methods: Twenty-three patients (23 feet) were treated with extracorporeal shockwave therapy for Achilles tendinosis, insertional tendonitis, or both. Indications for treatment were a minimum of 6 months of conservative care, and a visual analog pain score > 5. The mean follow-up was 20 months (range, 4–35 months). Results: Ninety-one percent (14 patients) were satisfied or very satisfied (23 patients) with treatment. Eighty-seven percent (20 patients) stated that extracorporeal shockwave therapy improved their condition, 13% (3 patients) said it did not affect the condition, and none stated that it made them worse. Eighty-seven percent (20 patients) stated they would have the procedure again if given the choice. Four months after extracorporeal shockwave therapy, the mean visual analog score for morning pain decreased from 7.0 to 2.3, and activity pain decreased from 8.1 to 3.1. Conclusion: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy. (J Am Podiatr Med Assoc 98(6): 466–468, 2008)

scholarly journals PO 18076 - Shockwave therapy associated with eccentric strengthening for Achilles insertional tendinopathy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 10S
Author(s):  
Tiago Soares Baumfeld ◽  
Nacime Salomão Barbachan Mansur ◽  
Fernando Villalon ◽  
Paulo Dos Santos ◽  
Bruno Shiefer ◽  
...  
Keyword(s):  
Achilles Tendinopathy ◽  
Foot And Ankle ◽  
Eccentric Training ◽  
Shockwave Therapy ◽  
Insertional Tendinopathy ◽  
Pain Visual Analog Scale ◽  
Global Pain ◽  
A Prospective Study ◽  
Insertional Achilles Tendinopathy

Introduction: Conservative treatment for insertional Achilles tendinopathy (IAT) has failed to produce encouraging results in recent years. Shockwave therapy (SWT) has become a reliable option for the management of this disease in recent years. The objective of this study is to report the effectiveness of low-energy SWT combined with an eccentric strengthening protocol in 19 consecutive patients. Methods: This is a prospective study of 19 patients diagnosed with IAT. The protocol consisted of SWT combined with eccentric training for 12 weeks. All patients were evaluated on the first day and after 24 weeks using the Victorian Institute of Sport Assessment-Achilles (VISA-A) score, the Pain Visual Analog Scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and algometry. The patients were also evaluated for compliance with the protocol, complications and final outcome. Results: All patients completed the study without complications. In total, 15 (79%) patients fully complied with the Alfredson protocol, and 13 (68%) considered the treatment successful. At the final evaluation, the patients required more pressure on the calcaneus to trigger pain (Algometry 1), reported less pain when applying the algometer with 3 kg of pressure (Algometry 2) and had less global pain (VAS) and higher AOFAS and VISA-A scores. All differences were significant. Conclusion: Eccentric training combined with SWT is an effective treatment for IAT. Further placebo-controlled studies with a longer follow-up are necessary to support this statement.

Shockwave Therapy Associated With Eccentric Strengthening for Achilles Insertional Tendinopathy: A Prospective Study

2019 ◽  
Vol 12 (6) ◽  
pp. 540-545 ◽  
Author(s):  
Nacime Salomão Barbachan Mansur ◽  
Tiago Baumfeld ◽  
Fernando Villalon ◽  
Bruno Takeshi Aoyama ◽  
Fabio Teruo Matsunaga ◽  
...  
Keyword(s):  
Prospective Study ◽  
Treatment Protocol ◽  
Achilles Tendinopathy ◽  
Shockwave Therapy ◽  
Insertional Tendinopathy ◽  
American Orthopaedic ◽  
Global Pain ◽  
A Prospective Study ◽  
Insertional Achilles Tendinopathy

Background. The usual initial treatment for insertional Achilles tendinopathy is nonsurgical. Yet there is no standard conservative treatment for Achilles insertional tendinopathy. Shockwave therapy (SWT) has become a reliable option for the management of this illness over the past years. The aim of this study is to report the effectiveness of low-energy SWT associated with an eccentric strengthening protocol in 19 consecutive patients. Methods. This is a prospective study with 19 patients aged between 26 and 72 years diagnosed with insertional Achilles tendinopathy. The protocol consisted of SWT associated with eccentric exercises for 12 weeks. All patients were evaluated on the first day and after 24 weeks (final follow-up) with the Victorian Institute of Sports Assessment–Achilles (VISA-A) score, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire, and by algometry. At the last follow-up, patients were also assessed for adherence to the protocol, complications and final outcome (in their perception as success or fail). Results and Conclusion. Fifteen (79%) patients were fully adherent to the Alfredson protocol, and 13 (68%) patients considered the treatment protocol successful. At the last evaluation, patients demanded higher pressure on calcaneus to trigger pain (algometry 1), reported less pain when the algometer was applied with 3 kg (algometry 2), had less global pain (VAS), and had higher AOFAS and VISA-A scores. This study evidences that eccentric loading associated with SWT can dramatically improve patients’ symptoms. We can conclude that eccentric loading associated with SWT is an effective treatment for Achilles insertional tendinopathy. Levels of Evidence: Therapeutic, Level III: Prospective cohort

Principles of bone and soft tissue imaging

Hand Clinics ◽  
2004 ◽  
Vol 20 (2) ◽  
pp. 147-166 ◽  
Author(s):  
Jeffrey J Peterson ◽  
Laura W Bancroft ◽  
Mark J Kransdorf
Keyword(s):  
Soft Tissue ◽  
Tissue Imaging

scholarly journals Molecular Tools for the Detection and Deduction of Azole Antifungal Drug Resistance Phenotypes in Aspergillus Species

2017 ◽  
Vol 30 (4) ◽  
pp. 1065-1091 ◽  
Author(s):  
Anna Dudakova ◽  
Birgit Spiess ◽  
Marut Tangwattanachuleeporn ◽  
Christoph Sasse ◽  
Dieter Buchheidt ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Invasive Aspergillosis ◽  
Initial Therapy ◽  
Resistance Testing ◽  
Sequencing Data ◽  
Management Options ◽  
Secondary Resistance ◽  
Content Type ◽  
Antifungal Drug Resistance ◽  
Geographical Regions

SUMMARY The incidence of azole resistance in Aspergillus species has increased over the past years, most importantly for Aspergillus fumigatus. This is partially attributable to the global spread of only a few resistance alleles through the environment. Secondary resistance is a significant clinical concern, as invasive aspergillosis with drug-susceptible strains is already difficult to treat, and exclusion of azole-based antifungals from prophylaxis or first-line treatment of invasive aspergillosis in high-risk patients would dramatically limit drug choices, thus increasing mortality rates for immunocompromised patients. Management options for invasive aspergillosis caused by azole-resistant A. fumigatus strains were recently reevaluated by an international expert panel, which concluded that drug resistance testing of cultured isolates is highly indicated when antifungal therapy is intended. In geographical regions with a high environmental prevalence of azole-resistant strains, initial therapy should be guided by such analyses. More environmental and clinical screening studies are therefore needed to generate the local epidemiologic data if such measures are to be implemented on a sound basis. Here we propose a first workflow for evaluating isolates from screening studies, and we compile the MIC values correlating with individual amino acid substitutions in the products of cyp51 genes for interpretation of DNA sequencing data, especially in the absence of cultured isolates.

Image guided radiotherapy: Current status of soft tissue imaging

Radiography ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 158-161 ◽  
Author(s):  
Helen A. McNair ◽  
Mark Elsworthy ◽  
June Dean ◽  
Charlotte Beardmore
Keyword(s):  
Soft Tissue ◽  
Tissue Imaging ◽  
Current Status ◽  
Image Guided Radiotherapy ◽  
Image Guided

Functional Gains Using Radial and Combined Shockwave Therapy in the Management of Achilles Tendinopathy

2021 ◽  
Author(s):  
Resident David M Robinson ◽  
Assistant Professor Can O Tan ◽  
Assistant Professor Adam S Tenforde
Keyword(s):  
Achilles Tendinopathy ◽  
Shockwave Therapy ◽  
Functional Gains

Soft-tissue disorders

2019 ◽  
pp. 135-158
Author(s):  
Karl B. Landorf ◽  
Anne-Maree Keenan ◽  
Rebecca Kearney
Keyword(s):  
Soft Tissue ◽  
Achilles Tendinopathy ◽  
Heel Pain ◽  
Tibialis Posterior ◽  
Tarsal Tunnel ◽  
Ankle Sprains ◽  
Common Occurrence ◽  
Tarsal Tunnel Syndrome ◽  
Plantar Heel Pain ◽  
Tunnel Syndrome

This chapter covers soft-tissue disorders, a common occurrence in rheumatology. There is a brief overview of 10 of the most common soft-tissue disorders of the foot in rheumatology, including Achilles tendinopathy, ankle sprains, retrocalcaneal bursitis, tarsal tunnel syndrome, peroneal tendinopathy, tibialis posterior tendinopathy, plantar heel pain, and more. For each disorder, presentation, signs, and management are discussed.

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