Researchers explore treatment options for insertional Achilles tendon injuries in athletes
A recent literature review showed nonoperative and operative management of insertional Achilles tendon injuries yielded positive outcomes for athletes, while biological treatments and less invasive procedures are still under investigation.
“Nonsurgical treatment with physical therapy, training modifications and appropriate footwear are the initial treatment of choice for individuals with tendinosis or low-grade partial tears,” Timothy L. Miller, MD, associate professor of orthopedics and sports medicine at The Ohio State University Wexner Medical Center, told Healio.com/Orthopedics. “When these conservative measures fail or if complete tendon rupture occurs at the calcaneal insertion, surgical treatment is often required to return an athlete to full function and previous activity level.”
Miller and colleagues noted nonoperative techniques, such as eccentric strengthening augmented with ultrasound and iontophoresis, led athletes to return to sport within 3 months to 6 months. Previously published results have also shown improvement in comfort and correction of overpronation with the use of orthotic devices, such as molded ankle-foot orthoses, heel cushions and semi-rigid corrective orthotic shoe inserts.
Surgical treatment should be applied if symptoms are not alleviated after 6 months of nonoperative treatment, if elite athletes are unable to refrain from sports participation or if the patient has a near-complete or complete tendon rupture. Tendon debridement with longitudinal repair, flexor hallucis longus tendon transfer and calcaneal anchor suture bridge technique are all possibilities for surgical technique.
Finally, while results regarding platelet-rich plasma treatments have been inconsistent, researchers found focused aspiration of soft tissue significantly improved mean VAS scores and led to a high rate of return to sport, as well as a decreased risk of surgical complications. Good-to-excellent outcomes, rapid recovery and minimal wound healing concerns have also been found among endoscopic treatment options. – by Casey Tingle
Disclosure: Miller reports no relevant financial disclosures.