Conservative treatment for recalcitrant Achilles tendinopathy in a soccer player: Case report and review of the literature

Abstract

Background Achilles tendinopathy (AT) management remains a major challenge and a consensus about the optimal conservative treatment for AT is yet to be reached. In this case report we described a multimodal conservative treatment protocol for a recalcitrant chronic AT. Furthermore, we performed a short narrative review about the formulated pathophysiological hypothesis and the conservative therapies we used in our case report. Materials and Methods Our patient was a 49-year-old, overweight, recreational soccer player who complained of pain at the left Achilles tendon that gradually increased week by week. The patient ascribed his pain to the use of low-quality soccer boots that he bought after the reopening of sports facilities after the COVID-19 pandemic. He also referred that he restarted playing soccer without any gradual progression. Clinical and ultrasound examination were suggestive of AT. We supposed an association between being overweight and the long detraining period and the development of AT as a possible pathophysiologic mechanism. Since the patient asked us for a rapid resolution of his symptoms, we then decided to set up a multimodal conservative treatment with focused extracorporeal shockwave therapy (f-ESWT), peritendinous hyaluronic acid (HA) injections, and eccentric exercises (EE). Results and Conclusions At the 45-day follow-up, significant improvements in pain, function, and ankle strength were found. There is no evidence about the effectiveness of a combined treatment (f-ESWT, HA and EE) for AT, so our multimodal protocol could be proposed as an effective approach in reducing AT in the short-term, especially for patients who need to get back to sport quickly.