BACKGROUND: Outcomes following radial extracorporeal shockwave therapy (rESWT) in patients with chronic noninsertional Achilles tendinopathy are investigated. METHODS: Patients with chronic noninsertional Achilles tendinopathy were recruited from a single National Health Services clinic, randomized equally to either therapeutic or minimal-dose (presumed sham) rESWT (3 sessions at weekly intervals). Both groups had an identical structured home rehabilitation program of progressive loading, balance, and stretching exercises. RESULTS: Fifty-seven patients were recruited; mean age 49.7 +/- 7.2 years, 60% female, symptom duration: 22.2 +/- 19.5 months. No between-group differences were identified at the final or any interim time points. Clinically and statistically significant within-group improvements were identified in pain/local function patient-reported outcome measures for both groups, with average pain improving by 34% at 6 months. No consistent benefits were seen in global function, activity levels, or mood. CONCLUSION: Recommended-dose rESWT is not superior to minimal-dose rESWT and may be ineffective for patients with chronic noninsertional Achilles tendinopathy.

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