For patients with Achilles tendinopathy who have completed a course of conservative management without adequate resolution of pain or tendon normalisation, a defined next-step protocol applies.

Previous Treatment & Escalation Criteria

The preceding management line may have included one or more of the following: topical glyceryl trinitrate patches combined with an eccentric exercise programme, sclerosing injections with Polidocanol into the area of neovascularisation, extracorporeal shock wave therapy, or peritendinous corticosteroid injection as an adjunct to exercise.

Goals not reached at 24 weeks:

Resolution of Achilles tendon activity pain
Absence of neovascularisation on colour Doppler ultrasonography
Decreased Achilles tendon thickness on ultrasonography

Next-Step Approach

When conservative treatment has not produced the expected response, a surgical approach directed at the Achilles tendon is the next step. The type and extent of the procedure depend on clinical findings. The treatment goal is resolution of Achilles tendon pain.

References

DOI: 10.1136/bjsm.2007.035543

Surgical treatment for tendons that fail to respond to conservative treatment can involve several procedures, all of which are designed to irritate the tendon and initiate a chemically mediated healing response.
These procedures range from more simple procedures such as percutaneous tenotomy to open procedures and removal of tendon pathology.
If conservative treatment is not successful, then surgery relieves pain in the majority of cases.

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Achilles Tendinopathy When Conservative Treatment Has Not Worked