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Journal ArticleDOI

Extracorporeal shockwave therapy for the treatment of Achilles tendinopathies: a prospective study.

TL;DR: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy.
Abstract: Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines ...

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Journal ArticleDOI
TL;DR: While ESWT is generally considered safe, physicians should be aware of potential major complications.

13 citations

Journal ArticleDOI
TL;DR: The mean pre and post-operative AOFAS scores were significantly improved at three and six months, and the postoperative VAS score improved significantly and was 0 at 2 years.
Abstract: Background: Insertional Achilles tendinopathy may be associated with Haglund’s deformity and result in chronic pain. It is usually refractory to conservative management. The aim of this study was to assess the outcome of calcaneoplasty performed in our hospital. Methods: Eight patients were prospectively evaluated pre- and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score, Visual Analogue Scale (VAS) and Short Form (SF) 36, as well as satisfaction rate. Average follow-up duration was 12.4 months. Results: The mean pre and post-operative AOFAS scores were significantly improved at three and six months. SF 36 improved in most parameters. The postoperative VAS score improved significantly and was 0 at 2 years. The procedure was rated as good to excellent by seven of the subjects. Conclusion: We recommend calcaneoplasty for the treatment of insertional Achilles tendinopathy.

13 citations

Journal ArticleDOI
TL;DR: The current treatments of tendinopathy with platelet-rich plasma (PRP) are briefly described, issues related to PRP treatment in clinics are highlighted, and the needs for basic science research on clinical usage of PRP for tendinopathic treatment are discussed.
Abstract: This article has two goals First, it reviews studies on tendinopathy in the literature while highlighting the following points: a) tendinopathy refers to a spectrum of tendon disorders with multiple facets of "tissue phenotypes," and b) mechanical loading is a major factor that contributes to the development of tendinopathy by inducing the aberrant differentiation of tendon stem/progenitor cells into non-tenocyte cell lineages Second, the current treatments of tendinopathy with platelet-rich plasma (PRP) are briefly described, issues related to PRP treatment in clinics are highlighted, and the needs for basic science research on clinical usage of PRP for tendinopathy treatment are discussed

10 citations

Journal ArticleDOI
TL;DR: In this article, the authors identified nine core domains for Achilles tendinopathy and identified 233 different outcome measures for each core domain with a range between 8 and 35 unique outcome measures utilized for each domain, with the proportion of studies that included outcomes for predefined core domains ranging from 4% for the psychological factors domain to 72% for disability domain.
Abstract: Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. Systematic review. Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. CRD42020156763.

8 citations

Journal ArticleDOI
TL;DR: The case of a 64-year-old female suffering from severe left heel pain for half a year and all treatment and rehabilitation were less effective until ESWT was applied, which revealed healing of the torn region and decrease in inflammation.
Abstract: Achilles tendinopathy is a common cause of posterior heel pain and can progress to partial tendon tear without adequate treatment Effects of traditional treatments vary, and many recent reports focus on the use of extracorporeal shockwave therapy (ESWT) for Achilles tendinopathy but not for Achilles tendon partial tear Here, we report the case of a 64-year-old female suffering from severe left heel pain for half a year All treatment and rehabilitation were less effective until ESWT was applied Each course of focused shockwave therapy included 2500 shots with energy flux density from 0142 mJ/mm2 to 0341 mJ/mm2 The visual analog scale decreased from nine to one degree High-resolution musculoskeletal ultrasonography was performed before and 1 month after the treatment, which revealed healing of the torn region and decrease in inflammation ESWT had shown to be an alternative treatment for Achilles tendon partial tear under safety procedure and ultrasound observation

5 citations

References
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Journal ArticleDOI
TL;DR: The Achilles tendon is the strongest tendon in the human body and there has been a general increase in popularity of sporting activities, but the number and incidence of the Achilles tendon overuse injuries and complete, spontaneous ruptures has increased in the industrialized countries during the last decades.
Abstract: The Achilles tendon is the strongest tendon in the human body. Because most Achilles tendon injuries take place in sports and there has been a general increase in popularity of sporting activities, the number and incidence of the Achilles tendon overuse injuries and complete, spontaneous ruptures has increased in the industrialized countries during the last decades. The most common clinical diagnosis of Achilles overuse injuries is tendinopathy. The basic etiology of the Achilles tendinopathy is known to be multi-factorial. Although histopathologic studies have shown that ruptured Achilles tendons have clear degenerative changes before the rupture, many Achilles tendon ruptures take place suddenly without any preceding signs or symptoms.

477 citations

Journal ArticleDOI
J.-D. Rompe, Ch. Hopf, K. Küllmer, J. Heine, R. Bürger1 
TL;DR: There was significant alleviation of pain and improvement of function after treatment in group I in which there was a good or excellent outcome in 48% and an acceptable result in 42% at the final review, compared with 6% and 24%, respectively, in group II.
Abstract: We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in tennis elbow. We assigned at random 100 patients who had had symptoms for more than 12 months to two groups to receive low-energy shock-wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm 2 and group II, the control group, 30 impulses. The patients were reviewed after 3, 6 and 24 weeks. There was significant alleviation of pain and improvement of function after treatment in group I in which there was a good or excellent outcome in 48% and an acceptable result in 42% at the final review, compared with 6% and 24%, respectively, in group II.

284 citations

Journal ArticleDOI
TL;DR: About every 10th patient treated surgically for chronic Achilles tendon overuse injury suffered from a postoperative complication that clearly delayed recovery, however, the majority of patients with a complication healed and returned to their preinjury levels of activity.
Abstract: We analyzed the complications after surgical treatment of Achilles tendon overuse injuries in 432 consecutive patients. The patients underwent a clinical examination 2 weeks, and 1, 2, and 5 months after the surgery. If a complication appeared, the patient was followed up clinically for at least 1 year. There were 46 (11%) complications in the 432 patients: 14 skin edge necroses, 11 superficial wound infections, 5 seroma formations, 5 hematomas, 5 fibrotic reactions or scar formations, 4 sural nerve irritations, 1 new partial rupture, and 1 deep vein thrombosis. Fourteen patients with a complication had reoperations: four patients for skin edge necrosis, two for superficial wound infection, two for seroma formation, one for hematoma formation, two for fibrotic reaction or scar formation, two for sural nerve irritation, and one for a new partial rupture. About every 10th patient treated surgically for chronic Achilles tendon overuse injury suffered from a postoperative complication that clearly delayed rec...

226 citations

Journal ArticleDOI
TL;DR: The current study showed that the directed application of electrohydraulic-generated shock waves to the insertion of the plantar fascia onto the calcaneus is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome.
Abstract: Three hundred two patients with chronic heel pain caused by proximal plantar fasciitis were enrolled in a study to assess the treatment effects consequent to administration of electrohydraulicall-generated extracorporeal shock waves. Symptoms had been present from 6 months to 18 years. Each treated patient satisfied numerous inclusion and exclusion criteria before he or she was accepted into this study, which was approved by the Food and Drug Administration as a randomized, double-blind evaluation of the efficacy of shock wave therapy for this disorder. Overall, at the predetermined evaluation period 3 months after one treatment, 56% more of the treated patients had a successful result by all four of the evaluation criteria when compared with the patients treated with a placebo. This difference was significant and corroborated the fact that this difference in the results was specifically attributable to the shock wave treatment, rather than any natural improvement caused by the natural history of the condition. The current study showed that the directed application of electrohydraulic-generated shock waves to the insertion of the plantar fascia onto the calcaneus is a safe and effective nonsurgical method for treating chronic, recalcitrant heel pain syndrome that has been present for at least 6 months and has been refractory to other commonly used nonoperative therapies. This technology, when delivered using the OssaTron (High Medical Technology, Kreuz-lingen, Switzerland), has been approved by the Food and Drug Administration specifically for the treatment of chronic proximal plantar fasciitis. The results suggest that this therapeutic modality should be considered before any surgical options, and even may be preferable to cortisone injection, which has a recognized risk of rupture of the plantar fascia and recurrence of symptoms.

220 citations

Journal ArticleDOI
TL;DR: Flexor hallucis longus tendon transfer/augmentation is a reasonable option for treatment of chronic Achilles tendinosis and rupture and revealed significantly lower scores in the physical function category when compared with United States norms.
Abstract: Chronic disorders of the Achilles tendon are commonly seen by the orthopaedic surgeon. In cases that are resistant to conservative treatment, a variety of surgical procedures have been utilized in the past. The indications for a previously described technique of flexor hallucis longus tendon transfer for reconstruction of chronic Achilles tendon rupture have been expanded to include further subsets of chronic Achilles tendinopathy, including rupture and tendinosis. We evaluated 20 patients (mean age 61) who underwent flexor hallucis longus transfer for treatment of chronic Achilles tendinopathy at a mean of 14 months following surgery. Our results were measured with the SF-36 survey, AOFAS Ankle-Hindfoot Scale, and Cybex strength and range of motion testing. Wound complications, tip-toe stance, and calf circumference were also assessed. There were no postoperative reruptures, tendinopathy recurrences, or wound complications. Despite a small loss of calf circumference, range of motion, and plantarflexion strength, 90% of patients scored 70 or higher on the AOFAS scale. SF-36 testing revealed significantly lower scores in the physical function category when compared with United States norms. Flexor hallucis longus tendon transfer/augmentation is a reasonable option for treatment of chronic Achilles tendinosis and rupture.

193 citations