Achilles Tendinopathy Toolkit: Section F - Medical and Surgical Interventions
Achilles Tendinopathy: Medical and Surgical Interventions[edit | edit source]
The purpose of this document is to summarize common medical and surgical interventions which may be considered for the management of Achilles tendinopathy – particularly if it is not responding adequately to more strongly supported conservative management strategies (see “Achilles Tendinopathy: Summary of the Evidence for Physical Therapy Interventions”).
Pharmacological Approaches[edit | edit source]
NSAIDS[1][edit | edit source]
Method | Short term benefit in the acute stage of tendinopathy to minimise inflammatory process. | |
Proposed Mechanism | Interrupts the chemical pathway of inflammation. | |
Benefit: Pros/Cons |
Pros: | Inexpensive, easily accessible. |
Cons: |
| |
Evidence |
Weak evidence for a modest effect in acute stage in Achilles tendinopathy. Recommendation for a short course of NSAIDs for acute symptoms within 14 days. No difference between oral or topical application. | |
Take Home Message |
PTs are involved in the treatment of tendon pain at all stages of recovery. General knowledge of commonly used NSAIDS is important for treatment planning. |
Corticosteroid (injection)[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Glycerol Trinitrate (GTN)[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Injection Therapies[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Polidocanol[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Prolotherapy[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Platelet Rich Plasma (PRP) and Autologous whole blood[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
High volume injection (HVI) or Hydrostatic dissection[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Dry Needling[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Dry Needline using a Hypordermic Needle ("tendon fenestration")[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Surgical Approaches[edit | edit source]
Percutaneous tenetomy[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Surgical debridement[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Minimally invasive stripping[edit | edit source]
Method | ||
Proposed Mechanism | ||
Benefit: Pros/Cons |
Pros: | |
Cons: | ||
Evidence | ||
Take Home Message |
Developed by Michael Yates, PT. BC Physiotherapy Tendinopathy Task Force. April 2012.
References[edit | edit source]
- ↑ McLauchlan , G, Handoll, H. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Collaboration of Systemic Reviews. 2009;2:1‐36.