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Achilles insertional tendinopathy: state of the art
  1. Nicola Maffulli1,2,
  2. Amol Saxena3,
  3. Emilio Wagner4,
  4. Guglielmo Torre5
  1. 1Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Fisciano, Italy
  2. 2Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
  3. 3Department of Sports Medicine, Palo Alto, California, USA
  4. 4Department of Orthopedics and Traumatology, Clinica Alemana, Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile
  5. 5Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
  1. Correspondence to Professor Nicola Maffulli, Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK; n.maffulli{at}qmul.ac.uk

Abstract

Achilles tendon pathology is a most common musculoskeletal condition in active individuals and athletes. Almost 6% of the general population will suffer from such ailment in their lifetime. Insertional Achilles tendinopathy (IAT) differs in its physiopathology, clinical features and treatment from midportion tendinopathy. The literature has mainly focused on assessment, outcome evaluation and treatment of IAT, although differences in management according to different geographical regions have not been addressed. The principles of clinical evaluation and imaging assessment of IAT are well established, with a major role of clinical assessment and soft tissue imaging, including ultrasonography and MRI. Conservative management options include eccentric training, extracorporeal shockwave therapy and prolotherapy, or a combination of these modalities. Recently, regenerative medicine has been more widely used, with at times dubious results. Surgery is advocated where conservative treatment is not beneficial within 6 months. Surgery includes more or less extensive debridement of peritendinous bony and soft tissue structures. To improve our knowledge about IAT, more evidence should be provided concerning innovative treatments, especially considering growth factors injections and percutaneous surgery.

  • ankle
  • tendon

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Footnotes

  • Contributors NM conceived the idea behind the manuscript, supervised the work and corrected the various draft. AS and EW provided the international perspective and corrected the various draft. GT wrote the first draft, performed the literature searches and coordinated the work. All the authors read and approved the final draft of this manuscript.

  • Funding No funding has been received for this work.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement All the data will be freely available on request to the corresponding author.

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