Achilles Tendinopathy

This chapter presents a case scenario of a 41-year-old male runner who presents with swelling 2.5 cm in diameter, 4 cm proximal to the insertion of the Achilles tendon. Several management options have been proposed to allow recovery of patients with Achilles tendinopathy (AT). Extracorporeal shockwave therapy (ESWT) may be a good option in these patients, and offers a potential alternative to other more invasive management modalities. The rationale for the use of platelet-rich plasma (PRP) to promote tendon healing is the high content of cytokines and cells in hyperphysiologic doses of PRP. Level I evidence demonstrates that there is no evidence to justify a PRP injection in patients with AT even when associated with appropriate physical therapy. Comparable results can be obtained with eccentric loading or low-energy ESWT. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.