Current evidences for the management of Achilles tendinopathy

Abstract

Tendinopathy is one of the most frequent overuse injuries associated with sport. Although many nonoperative and operative treatments for the management of Achilles tendinopathy have been proposed, the best treatment of these patients is still controversial. We performed an overview of the evidences supporting the several treatments described for the management of Achilles tendinopathy. The first-line treatment should be the physical therapy based on an appropriately performed program of eccentric exercises. If the tendinopathy is refractory, shockwave therapy could be considered as second-line intervention. Moreover, these two approaches can be combined. Finally, high-volume injection can reduce pain and improve long-term function in patients with Achilles tendinopathy. On the other hand, the use of injectable substances, such as platelet-rich plasma, autologous blood, polidocanol, and corticosteroids in and around tendons is not supported by strong clinical evidence. Surgery may be considered in patients who failed to improve with appropriate nonoperative treatments. However, the best surgical management is still controversial because of no randomized controlled trials have been performed to compare different surgical techniques.