Intramuscular corticosteroids combined with exercise for refractory midportion achilles tendinopathy: A case series

Background

Treatment of Achilles tendinopathy (AT) typically consists of progressive exercise, load management, and patient education. The use of paratendinous administration is controversial. Improvement with conventional measures is often insufficient, creating a need for alternative solutions.

Purpose

Purpose is to describe the outcomes of patients treated with intramuscular corticosteroid-injections in combination with exercises.

Study design

retrospective analysis of a case series.

Methods

Baseline data and short-term outcomes were collected from patient records treated in our clinic. Follow-up results were gathered by means of structured telephonic interviews. AT was defined as pain in the Achilles tendon during activities with at least two of the following criteria: pain on tiptoe standing, swelling and/or tenderness 2–7 cm above the insertion, ultrasound signs of tendinopathy.

Results

Ten patients were included. The median duration of symptoms was 12 months (IQR 23). Patients reported improvement after 5.6 days (SD 4.8).The treatment reached its maximum effect at 6.2 weeks (SD 3.4). At the end of the 2–12 week intervention, six patients felt completely recovered and four reported feeling much better. At follow-up (23 months, SD 17), seven patients felt completely recovered and three much better. The median NRS pain score changed from 8 at baseline to 0 (p = 0.002), and the mean VISA-A score from 37 to 95 (p < 0.0001). No major adverse events were observed.

Conclusion

one or two intramuscular corticosteroid injections combined with concentric–eccentric exercises may offer rapid and sustained relief for patients with midportion AT.

Level of Clinical Evidence

4