Shockwave therapy is an evidence‑based treatment that can significantly reduce pain and improve function in people with chronic insertional Achilles tendinopathy, particularly when combined with a structured physiotherapy programme.

Shockwave therapy for insertional Achilles tendinopathy is an excellent adjunct to standard physiotherapy management in patients with significant levels of pain here’s why. Like most tendinopathy treatment plans exercise therapy including a strength plan are absolute key therapy options but progress can be difficult by the heel pain patients suffer. Using shockwave therapy for insertional Achilles tendinopathy helps to get control of the pain quickly and progress suitable exercise therapy in around 80% of patients. It’s a great non invasive alternative to steroid injection or surgery and its available with no waiting lists at Physis Physiotherapy in Edinburgh. So what do patients need to know from this blog?

What is insertional Achilles tendinopathy?

Insertional Achilles tendinopathy is a common cause of posterior heel pain in both sedentary and active people. It is often a chronic, frustrating injury which effects active adults aged between 30 and 60 years of age, particularly those who are engaged in regular sporting activity such as running (Zhang et al., 2020; Furia, 2006).

It is characterised by pain, swelling, morning stiffness and tenderness on the attachment of the Achilles tendon onto the heel bone, known as the calcaneum (green circle on the image below).

The other common type of Achilles tendon injury is called mid-portion Achilles tendinopathy. This injury is located above the heel bone towards the muscle belly (blue circle on the image below). Both mid-portion and insertional Achilles tendinopathy can be a very painful and debilitating condition which can be difficult to treat.

What causes insertional Achilles tendinopathy?

Insertional Achilles tendinopathy is associated with injury and/or overuse. However, while the exact cause is often unknown, there are certain risk factors such as impact based sports and activities such as running, tennis, volleyball and football. This condition is particularly common in runners who have:

• increased their mileage too quickly
• started running too often
• recently incorporated hill training
• changed their running shoes

Some individuals are genetically prone to tendon issues particularly those with collagen (connective) tissue conditions. Those who are overweight, diabetic or have high cholesterol are also more likely to get insertional Achilles tendinopathy and often these patients take longer to fully recover. Advancing age has also been shown to be a known risk factor.

Other intrinsic risk factors include overpronation (flat feet), stiffness in the ankle joint or hips and/or a leg length discrepancy (Furia, 2006).

Is shockwave therapy for insertional Achilles tendinopathy effective?

Shockwave therapy is an effective option for treating chronic insertional Achilles tendinopathy, particularly when other nonoperative treatments have failed such as physiotherapy, rest, orthotics and medication (NSAIDs) have failed to produce satisfactory results (Al-Abbad and Simon, 2013, Mani-Babu et al., 2015).

The use of shockwave therapy for Achilles tendinopathy is well supported by the National Institute for Health and Care Excellence (NICE). NICE provides national guidance and advice to improve health and social care. It provides evidence based recommendations to guide best practice within healthcare.