Title: Eccentric Loading, Shock-Wave Treatment, or a Wait-and-See Policy for Tendinopathy of the Main Body of Tendo Achillis
Authors: Jan D. Rompe, MD, Bernhard Nafe, MD, John P. Ruria, MD, PhD, and Nicola Maffulli, MD, PhD, FRCS(Orth)
Source: The American Journal of Sports Medicine 2007, Vol 35, No. 3, 374-383
PODIATRIC RELEVANCE:
There have been several different treatments advocated dealing with chronic tendinopathy of the main body of the Achilles tendon. There have been only a few randomized controlled trials comparing these methods of management of this particular pathology of the Achilles tendon. This study compares two treatment regimens (Eccentric loading and SWT) that are becoming a mainstay in management of chronic Achilles tendinopathy to a wait-and-see policy of treatment.
METHODS:
Seventy-five patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peri-tendinous local injections, (2) non-steroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule. Analysis was on intent-to-treat basis.
RESULTS:
At 4 months from baseline, the Victorian Institute of Sport Assessment (VISA)-A score increased in all groups, from 51 to 76 points in group 1 (eccentric loading), from 50 to 70 points in group 2 (repetitive low-energy SWT), and from 48 to 55 points in group 3 (wait and see). Pain rating decreased in all groups, from 7 to 4 points in group 1, from 7 to 4 points in group 2, and from 8 to 6 points in group 3. Fifteen of 25 patients in group 1(60%), 13 of 25 patients in group 2 (52%), and 6 of 25 patients in group 3 (24%) reported a Likert scale of 1 or 2 points (“completely recovered” or “much improved”). For all outcome measures, groups 1 and 2 did not differ significantly. For all outcome measures, groups 1 and 2 showed significantly better results than group 3.
COMMENTS:
This randomized controlled trial study has shown that eccentric muscle training and SWT have results that are superior to a wait-and-see method, similar to one another, and comparable to surgery (50-60% successful outcome for eccentric loading and SWT). This study would further benefit from the comparisons of combined management and also comparisons to other treatment regimens including surgical treatment.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.