Insertional Achilles Tendinopathy Management: A Systematic Review

Background: Achilles tendinopathy is a common problem and its management remains controversial. However, many clinicians consider that the sub-group of patients with insertional Achilles tendinopathy are even more difficult to manage. The aim of this systematic review was to review evidence for interventions specific to insertional Achilles tendinopathy. Materials & Methods: Medline and the Cochrane library were searched using a pre-defined search strategy. All study designs were included except case studies, narrative reviews, technical notes and letters/personal opinion. The results were evaluated independently by two reviewers and assessed against the inclusion/exclusion criteria. All included articles were assessed for methodological quality and study characteristics were extracted into a table. Results: One hundred eighteen articles were identified through the search strategy, of which 11 met the eligibility criteria. Six studies evaluated operative techniques following failed conservative management and five evaluated conservative interventions only. The overall level of evidence was limited to case series evaluations and one randomized controlled trial. Conclusion: There is a consensus that conservative methods should be used before operative interventions. Current evidence for conservative treatment favors eccentric loading and shock wave therapy, although there is limited evidence by which to judge their effectiveness. Evaluation of operative interventions has been mostly retrospective and remains inconclusive.