a bony growth called a bunion on a patientAmong foot and ankle conditions, Achilles tendinopathy (or tendinitis) is a common condition treated in orthopaedic sports medicine. It’s a painful condition that arises because of repeated tears to the tendon fibers with haphazard or disorganized scarring. It often presents as a painful lump in the mid-portion of the Achilles tendon.

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Those who suffer from Achilles tendinopathy may experience pain and swelling which is why it was once called Achilles “tendinitis”. If it was just inflammation of the tendon, a little prednisone/corticosteroid or NSAIDs (ibuprofen, naproxen, etc.) would be the solution. Many who have this condition will learn that these medications often do nothing to improve their symptoms.

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The Achilles tendon joins the heel bone to the calf muscles including the gastrocnemius and the soleus. Repeated microscopic injuries to the Achilles tendon have a cumulative impact, and the damage can occur due to overuse or “recovery debt” of the tendon. While the injury is notorious among runners, other sprinting, jumping, or heel-rising athletes or dancers are also impacted. However, one-third of those with this condition lead a sedentary lifestyle.

The cumulative damage and disorganized collagen fibrils need to be re-educated with a regenerative solution. This is an active healing process and won’t go away with just rest alone. One must be proactive in getting this stubborn tendon to heal. The Achilles has little blood flow at its mid-substance and often needs something to SHOCK it into healing.

The standard treatment for Achilles tendinopathy may include:
Formal Physical Therapy- CONTACT P.O.W.er PT at (412) 357-1017
Eccentric loading- up on 2 down on 1 exercises- see the Alfredson Protocol below.
Stretching- gastrocnemius and soleus
Heel Lifts
Night splinting for equinus contractures
Rest (Relative rest that is, avoidance of painful activities)
Infra-red heat, deep tissue massage, modalities
PRP or platelet-rich plasma injections- CONTACT P.O.W. at (412) 525-7692 do give ACP a try.

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Surgical treatments ONLY when conservative methods have failed For most people, the symptoms of Achilles tendinopathy are usually resolved within 3-6 months after starting a comprehensive treatment program. Patients seeking relief from the pain and inflammation present in this debilitating condition are looking for ways to get back to an active, healthy lifestyle.

Increasingly, physicians are turning to regenerative medicine technologies like FSWT (Focused Shockwave Therapy) and RSW (Radial Sound Wave, also known as Radial Pressure Wave) and/or a combination of the two shockwave therapies for a novel non-invasive approach.

A retrospective cohort study by Robinson et. al. of the Spaulding Rehabilitation Hospital at Harvard Medical School, was recently published in The Journal of Foot & Ankle Surgery. The study titled 'Functional Gains Using Radial and Combined Shockwave Therapy in the Management of Achilles Tendinopathy' looked at radial shockwave therapy or combined shockwave therapy (radial + focused) for patients with AT resistant to exercise therapy.

While shockwave has been shown to improve function in AT patients in numerous studies, until now, there has not been a study comparing RSW to a combination of both RSW and FSW and reveals outcomes related to the treatment of Achilles tendinopathy.

At the outset, the authors hypothesized that patients receiving RSWT and CSWT (combined shockwave therapy) would see an improved function with similar safety outcomes. Some patients elected to receive CSWT after not achieving satisfactory results with RSWT.

The STORZ Medical EPAT device (AS AVAILABLE AT P.O.W.), the OrthoPulse Ultra 100, was used for all RSWT treatments, using 2 applicator heads each for a minimum of 3000 strikes at 15 Hz and set for a minimum pressure was 1.8 (range 1.8-4.5) Bar applied over areas of pain.

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As hypothesized, the study confirmed the majority of patients receiving RSWT (EPAT) alone experienced clinical improvement with shockwave treatment. All had been previously resistant to physical therapy treatment for relief of Achilles tendinopathy.

In conclusion, the findings collectively suggest that most patients suffering from chronic AT may achieve functional gains using ESWT.


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