Achilles Tendinopathy Treated With Training and Injections

Achilles tendinopathy is a common and often longlasting condition especially in a sports population. The highest incidence is seen in sports involving running and jumping.

As the primary treatment eccentric exercises is recommended and 60-90% will benefit by that. Other studies have shown equal effect of stretching exercises. In a new study heavy slow resistance exercises has proven effective in achilles tendinopathy and the best treatment in lig.patellae tendinopathy.

Injection with glucocorticosteroid is often used in the daily clinic, though inflammation is rarely found. Fredberg 2004 found a good short term effect of glucocorticosteroid injection in an RCT, but no effect in the long term, which the investigators explained by an aggressive rehabilitation with running after a few days. Even though 60-90% will benefit from exercises in efficacy studies, a recent pragmatic effectiveness study by Weetke 2015 found that only 26% did benefit from training alone, but if supplemented by need with 1-3 injections of glucocorticosteroid 76% achieved excellent or good result.

To our knowledge no randomized clinical trials have investigated the combined effect of training and injections. The hypothesis of this study is, that training and slowly progressive rehabilitation combined with glucocorticosteroid injections will have better effect than the same training and rehabilitation combined with injections of local anesthetic.

Inclusion criteria

• Midsubstance pain in the achilles tendon
• Symptoms for at least 3 months
• Ultrasound scanning at the first visit shows thickness of the achilles tendon above 7 mm or 20% thicker than the contralateral.
• Patient can read and understand danish

Exclusion criteria

• Earlier operations in the foot and leg, that is judged to complicate training
• known arthritis.
• known diabetes
• Leg ulcerations or infections in the foot.
• Judged unable to comply with the training protocol.
• Daily use of pain killers
• Glucocorticosteroid injection to the diseased achilles tendon within the last 6 months.
• Earlier allergic reactions to glucocorticosteroid or local anesthetic.
• Pregnancy or planning to become pregnant
• BMI above 30.