BACKGROUND: The therapeutic efficacy of non-surgical treatment strategies in Achilles tendinopathy (AT) has not been well clarified. Time-consuming and costly combinations of treatment for pain, physiotherapy and biomechanical procedures are often applied. OBJECTIVE: To analyse the efficacy of single therapeutic regimens commonly used over a short period of 4 weeks. METHODS: 31 male runners (mileage > 32 km/week) with unilateral, untreated AT completed 4 weeks of either physiotherapy (10 treatments: deep-friction, pulsed ultrasound, ice, sensory motor training; (P)), wearing custom fit semirigid insoles (I) or remained without treatment (control group C). Before and after treatment, all patients underwent a treadmill test and a plantar flexion strength exercise. Subjective pain (Pain Disability Index, Pain Experience Scale), as well as strength performance capacity (peak torque), was analysed (mean, 95% CI, repeated measures analysis of variance, alpha = 0.05). RESULTS: Pain was reduced to < 50% of the baseline value after physiotherapy or after wearing insoles (p < 0.05). Individual pain reduction was > 50% (25%) in 89% (100%) of subjects in I and 55% (73%) in P. Higher eccentric plantar flexion peak torques after treatment were observed in I and P. CONCLUSIONS: Most patients with AT experience a reduction in pain after only 4 weeks of differentiated, non-surgical treatment consisting of physiotherapy or semirigid insoles.
Reproduced with permission from the BMJ Publishing Group.

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