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  1. Reem Elmallah1,
  2. Enas Elattar2
  1. 1faculty of medicine Ain Shams University, Assistant Professor of Physical Medicine, Rheumatology and Rehabilitation, cairo, Egypt
  2. 2Faculty of Medicine. Ain Shams University, Assistant Professor of Physical Medicine, Rheumatology and Rehabilitation, cairo, Egypt


Background Achilles tendinopathy (AT) is considered as one of the common tendon pathologies, which occurs mainly in athletes. Different conservative treatment options have been introduced and used for symptoms relief of At but with short-term effect.1 Extracorporeal shockwave treatment (ESWT) provides longer effects and could be used in cases fail to respond to conservative treatments.2 Mesotherapy is widely practiced in sports medicine as multiple injections, often of anti-inflammatory medications into the subcutaneous fat overlying a region of musculoskeletal pain. The effect appears unclear but may be due to localized tissue uptake of anti-inflammatory medication which may provide symptomatic relief especially in insertional Achilles tendinopathy 3

Objectives In this study, we aimed to evaluate the effect of extracorporeal shockwave treatment

(ESWT)and mesotherapy on chronic Achilles tendinopathy in athletes

Methods 40 patients with chronic AT were diagnosed clinically & using high resolution ultrasound (US) according to the Eular guide lines and randomly allocated in two groups, first receive ESWT, other group underwent mesotherapy (MT) one session once a week for 4 weeks to the 2 groups. Pain, ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS) 4 & US were recorded at baseline, 4 and 12 weeks after intervention

Results Both groups improved during the treatment and follow-up period. The mean VAS score decreased from 7.55 to 3 in the ESWT group and from 7.70 to 4.30 in MT group. There was no significant difference in terms of AOFAS and VAS scores between both groups at 4 weeks follow up while Mean AOFAS & VAS scores were significantly different between ESWT and MT groups at 12 weeks of follow-up (P = 0.013) (P = 0.47). US assessment significantly improved after 12 weeks in ESWT group as regards tendon thickness, calcifications(figure1,2) and doppler signal.

Conclusion ESWT showed improvement of pain and inflammation of AT than MT injections which was documented by the decreased VAS, increased AOFAS scores as well as US improved findings shortly after the treatment as well as on late follow up.

Keywords: Achilles tendinopathy, extracorporeal shockwave therapy, pain, visual analog scale, mesotherapy

References [1] Diehl P, Gollwitzer H, Schauwecker J, Tischer T, Gerdesmeyer L. Conservative treatment of chronic tendinopathies. Orthopade. 2014;43:183–93.

[2] Moayednia A, Haghdani S, Khosrawi S, Yousefi E, Vahdatpour B. Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis. J Res Med Sci. 2014;19:293–6

[3] Paoloni J. Current Strategy in the Treatment of Achilles Tendinopathy. In: čretnik Andrej., editor. Achilles’tendon. InTech Rijeka; Croatia: 2012

[4] Madeley NJ, Wing KJ, Topliss C et al. Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int 2012;33:57–63

Fig (1) Ultrasound Transverse scan over left TA of male 25 squash player shows hyperechoic dot of calcification inside the tendon with acoustic shadowing before treatment.

Fig(2) same patient, after 3 months of treatment with ESWT shows disappearance of calcification

Disclosure of Interests None declared

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