Current Treatments of Insertional Achilles Tendinopathy
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SPORTS MEDICINE REHABILITATION (BJ LIEM AND B KRABAK, SECTION EDITORS)
Current Treatments of Insertional Achilles Tendinopathy Mark Sederberg 1
&
Daniel M. Cushman 1
Accepted: 3 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This paper aims to review the pathophysiology, diagnosis, and treatment of insertional Achilles tendinopathy (IAT). Recent Findings There is no current consensus regarding conservative or surgical treatments for IAT. There has recently been an increase of trials demonstrating utility for extracorporeal shock wave in treating IAT. Additionally, a retrospective study of percutaneous ultrasonic tenotomy shows promise. Summary IAT has historically been recalcitrant to treatment. There are multiple available treatment options, and many that may confer some benefit. Knowing the available conservative treatment options and discussing the risks and benefits with the patient can help the patient and clinician determine what treatment options to employ for each individual. Keywords Achilles tendon . Insertional Achilles tendinopathy . Tendinopathy . Enthesopathy . Achilles tendinitis . Heel pain
Introduction The Achilles tendon (AT) is the largest tendon in the human body and is commonly injured. Chronic injury to the AT can be divided into insertional Achilles tendinopathy (IAT), with pathology at the insertion of the tendon or the enthesis, and midportion or non-insertional Achilles tendinopathy (NIAT), with pathology 2–6 cm proximal to the tendon insertion. Though these conditions affect the same tendon, they have distinct etiology, pathology, treatment, and outcomes. Many conservative treatment options exist; however, many patients fail conservative treatment and undergo surgery.
Epidemiology Achilles tendinopathy is one of the most common lower extremity injuries. It is estimated to cause 32% of lower extremity injuries in runners [1]. About 20–35% of cases of Achilles This article is part of the Topical Collection on Sports Medicine Rehabilitation * Mark Sederberg [email protected] 1
Division of Physical Medicine & Rehabilitation, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
tendinopathy affect the insertion [2]. IAT is thought to be more common in physically active individuals, especially in those who participate in middle and long-distance running [3, 4]. One study noted that those with IAT were of a similar age, but had a higher BMI and self-identified as less active than those with NIAT [5]. However, most studies on risk factors for AT did not differentiate between IAT and NIAT, and therefore its unique risk factors remain unknown [6]. Medical risk factors that correlated with Achilles tendinopathy without differentiation between types include increased age, male sex, hypertension, obesity, diabetes, steroid use, or fluoroquinolone use [7]. Inflammatory arthropathies such as ankylosing spondylosis and psoriatic arthritis can present with painful IAT as part of a constellation of symptoms. Bio
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