From the Guidelines
Steroid injections should not be used for insertional Achilles tendinopathy due to the potential risks of tendon weakening and increased rupture risk. Conservative treatments should be tried first, including rest, physical therapy focusing on eccentric exercises, orthotics, and non-steroidal anti-inflammatory drugs (NSAIDs) for pain management 1. If these approaches fail, other interventions like extracorporeal shock wave therapy or platelet-rich plasma injections may be considered before turning to steroid injections. The use of local corticosteroid injections in tendinopathy is not supported by evidence-based guidelines, and there may be deleterious effects on the tendon when they are injected into the tendon substance 1.
Some key points to consider when treating insertional Achilles tendinopathy include:
- Avoiding the use of steroid injections as a first-line treatment due to the potential risks 2
- Focusing on conservative treatments such as rest, physical therapy, and orthotics to manage symptoms and promote healing
- Considering alternative interventions like extracorporeal shock wave therapy or platelet-rich plasma injections if conservative treatments fail
- Informing patients of the potential risks associated with steroid injections, including tendon weakening and increased rupture risk, and advising them to gradually return to activities following any injection, avoiding sudden increases in tendon loading 1.
It is essential to prioritize the patient's safety and well-being when treating insertional Achilles tendinopathy, and to carefully weigh the potential benefits and risks of any treatment approach, including the use of steroid injections 1, 2.
From the Research
Treatment Options for Insertional Achilles Tendinopathy
- Conservative treatment options include reduction of activity levels, administration of non-steroidal anti-inflammatory drugs (NSAID), adaptation of footwear, heel wedges and orthoses or immobilization, eccentric stretching exercises, and extracorporeal shock wave therapy 3, 4, 5
- Eccentric stretching exercises can achieve a 40% reduction in pain, while extracorporeal shock wave therapy has been shown to reduce pain by 60% with a patient satisfaction of 80% 3
- Injections with platelet-rich plasma (PRP), dextrose (prolotherapy) or polidocanol (sclerotherapy) cannot currently be recommended due to limited evidence 3
- Steroid injections are not recommended as a first-line treatment option, and their use is not supported by the available evidence 5
Surgical Treatment Options
- Operative therapy is indicated after 6 months of unsuccessful conservative therapy 3
- Open debridement allows all pathologies to be addressed, including osseous abnormalities and intratendinous necrosis, with a success rate of over 70% 3
- However, complication rates of up to 40% have been reported for open debridement 3
- Tendoscopy is a promising treatment option for isolated retrocalcaneal bursitis, with similar success rates to open debridement and significantly lower complication rates 3
Use of Steroid Injections
- There is no evidence to support the use of steroid injections as a treatment option for insertional Achilles tendinopathy 3, 4, 5
- In fact, the available evidence suggests that injections should only be considered after other nonoperative treatment options have been exhausted, and particularly to facilitate participation in an exercise program 5