Mid-portion Achilles tendinopathy--current options for treatment.

PURPOSE: To report on the present option for management of tendinopathy of the main body of the Achilles tendon.

BACKGROUND: Tendinopathy of the main body of tendo Achillis affects athletic and sedentary patients. Mechanical loading is thought to be a major causative factor. However, the exact mechanical loading conditions which cause tendinopathy are poorly defined. Repetitive mechanical loading induces a non-inflammatory pathology, and repetitive microtrauma ultimately exceeds the healing response. The management of Achilles tendinopathy is primarily conservative. Although many non-operative options are available, few have been tested under controlled conditions. This review article specifically focuses on eccentric training, and on shock wave therapy. Surgical intervention can be successful in refractory cases. However, surgery does not usually completely eliminate symptoms and complications are not rare.

CONCLUSIONS: Further studies are needed to discern the optimal non-operative and surgical management of midsubstance Achilles tendinopathy.