Achilles tendinopathy

Imaging - Please include an up to date X ray with weight bearing views report within or attached to the referral. This includes for soft tissue injuries to exclude underlying pathology. .

Referrals without up to date reports included and Xrays that are not weight bearing will be returned, unless there are mitigating circumstances why this is not possible

Arrange admission or refer urgently to Fracture clinic via the on-call Orthopaedics SHO if Achilles tendon tear/rupture suspected - link to Thompson’s test

The symptoms of Achilles tendinopathy usually take 12 weeks to resolve.

Conservative measures:

Rest
Analgesia & Cold packs
Exercises
Heel lifts
At least 6 months of intensive physio(check compliance: stretches need to be done 3-4 times/day)

Non-surgical treatments available in secondary care:

In resistant cases the patient may be considered for ESWT Extracorporeal Shock Wave Treatment

-Refer to Exeter via Radiology department (paper referral to MSK Radiology Department Royal Devon and Exeter Hospital)

-Private referral can be made (£55 per treatment, 3-4 treatments recommended) at the Duchy

If fails to respond to treatment by local physio refer to specialist physio for eccentric exercises

Refer for Surgery:

Diagnostic uncertainty
After 6 months if conservative measures (including physiotherapy) have failed

Do not inject corticosteroids into or around the tendon. Any possible benefit of corticosteroid injections is outweighed by potential adverse effects

Surgical options are limited and is a last resort

There is no role for diagnostic USS in the primary care management of Achilles Tendinopathy

REFERENCES:

NICE Clinical Knowledge Summaries Achilles Tendinopathy: https://cks.nice.org.uk/achilles-tendinopathy#!scenario

Date reviewed 25/06/2019

Next review due 25/06/2020

Sifter name Dr Rebecca Hopkins

Version No. 1.1