Achilles Tendinopathy: A Treatment Algorithm, New Options


As technology in medicine continues to advance, new treatment options for Achilles tendinopathy are becoming more accessible to the public. Understanding these options can help you understand the potential outcomes of the procedure. This short guide will provide essential information about recent developments in the fields related to the treatment of this painful condition.

Overview of Achilles Tendinopathy

This condition is commonly understood to be an inflammatory response, which takes place after an acute injury. However, there is a difference between this condition and other inflammatory injuries. In Achilles tendinopathy, there is a failure of the normal healing response, which is a part of the normal inflammatory process in similar injuries. This requires a unique treatment approach.

Under some circumstances, it can also happen in sedentary individuals as a part of a chronic condition. The Achilles tendon will responds to any tearing in the tissue, and nerves will attempt to grow as a part of the natural healing response. This is a very painful state of wound repair, and it can get worse when the injured foot is subjected to normal weight-bearing activities. The latest studies indicate that a successful treatment algorithm should begin with a conservative approach.

The Conservative Approach

The conservative approach to treating Achilles tendinopathy may use a variety of methods, and it will avoid using invasive techniques. This means that there is also a lot of interest in exploring new approaches as they emerge. This is also important because the existing literature does not offer a wide range of conservative treatment options. Any additional remedy tends to be greeted with enthusiasm by treatment practitioners.

The conservative approach requires a comprehensive evaluation of the specific condition faced by the patient. This includes specific testing, documentation and evaluation. Once the diagnosis is confirmed, there are conservative treatment options available to the clinician. The most common treatment performed at this stage may include electrotherapy, which uses either microwaves or micro-currents. Other options include sclerosing injections or patches. Non-steroidal anti-inflammatory drugs, or NSAIDs, are also proven to have clinical benefits. This approach typically addresses the symptoms and encourages the conditions that allow the body to heal.

Treating Achilles Tendinopathy

Even during this stage of the algorithm, discretion is needed to select the most effective treatment option without inflicting unnecessary trauma into the area. This may involve the use of orthotics in conjunction with physical therapy exercises for strengthening and stretching. Additional recommendations of rest or modifications in daily activities often assist with the healing process. Treatments can be altered or modified as additional feedback from the patient becomes available. For example, some patients will report additional symptoms like a decrease in the capacity for handling a normal load. Stiffness and a lack of mobility in the morning may also indicate a need for a treatment adjustment.

The skill of the clinician is an important factor for a successful treatment protocol. Once the patient receives a complete evaluation, the treatment plan can be designed to address the main symptoms. This has been shown to be an effective algorithm for 75 percent of patients with Achilles tendinopathy. This type of treatment approach effectively minimizes the potential for an invasive procedure to be prematurely proscribed. This algorithm was designed to conform to traditional clinical principles that seek to minimize harm to patients.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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