Evidence-Based Management of Achilles Tendinopathy in the Athletic Population

To synthesize the available literature on the pathogenesis, diagnosis, and treatment of Achilles tendinopathy.

Achilles tendinopathy is predominantly a noninflammatory condition in which collagen remodeling fails during the attempted healing phase. Extracorporeal Shockwave Therapy (ESWT) and platelet-rich plasma are emerging therapies with excellent safety profiles. Percutaneous ultrasonic tenotomy has shown to be a viable option for refractory noninsertional Achilles tendinopathy.

Achilles tendinopathy is categorized by anatomical location. Diagnosis is largely clinical, however, diagnostic ultrasound is the preferred imaging modality. Currently, there is no gold standard treatment for Achilles tendinopathy. Eccentric and concentric exercises are suggested first-line treatment. Pharmacological options remain limited and vary based on chronicity. Corticosteroid injections have fallen out of favor, but sclerotherapy, ESWT, platelet-rich plasma and high-volume image-guided injections are options for chronic cases. If 3-6 months of conservative management fails, the clinician can consider percutaneous ultrasonic tenotomy or more invasive surgery.