Case Study May 2018 – Shock Wave Therapy for Achilles Tendonitis

A 32 YEAR OLD FEMALE RUNNER PRESENTS TO THE SYDNEY HEEL PAIN CLINIC FOR SHOCKWAVE THERAPY TO HER ACHILLES TENDONITIS.

Shockwave therapy is becoming increasingly popular for the treatment of ailments such as Achilles tendonitis. shockwave therapy is used in order to stimulate healing and create revascularization of the tissue. There are also pain-relieving benefits relating to shock wave therapy, although this is not the main reason for the treatment. Sessions are usually given at 5, 6 or 7 day intervals. There are other treatments for Achilles tendonitis and shockwave therapy is usually done in addition to other therapies such as biomechanical assessments and footwear recommendations etc. If used as a stand alone treatment, shock wave therapy may not always be beneficial, especially if the practitioner has failed to identify other problematic factors. Patient education is crucial and at the Sydney heel pain clinic the patient is given a mobile phone application containing detailed information pertaining to their treatment.

This particular patient had been complaining of Achilles tendonitis for more than 6 months and had received a variety of treatments for the condition. She had engaged in 6 weekly sessions of acupuncture and dry needling and had been stretching her calf muscles diligently. She was also carrying out eccentric loading exercises, as per the advice of a physiotherapist. She reported that the Achilles tendonitis had become increasingly painful throughout the duration of these eccentric loading exercises, therefor she decided to stop. The patient decided to stop using her current running shoe and purchased a newer and stronger style of running shoe in order to give her feet more support. The change of running shoes did not seem to relieve the problem and the condition persists. The patient describes a sharp pain and a dull ache through the shaft of the Achilles tendon which causes pain first thing in the morning when she rises from her bed and also pain during her exercise regime. The patient reports to the sports podiatrist that she carries out 3, 5 km runs during the week and one 15 km run on a Saturday. Pain from the Achilles tendonitis is prominent during the start of the run but decrease within the first 5 minutes. She also reports significant pain for the for the two hours that follow the run. A colleague the patient works with suggested that she try shockwave therapy as she herself had treated her Achilles tendon with the same approach. To this end, the patient came to the Sydney heel pain clinic and requested Shockwave therapy for her Achilles tendonitis.

The sports podiatrist carried out a detailed biomechanical assessment to determine whether or not there were other factors to consider. Sports podiatrist did confirm that the patient had a relatively stable foot style and there did not seem to be pronation issues. The sports podiatrist recorded the patient’s foot function using digital software on an iPad and replayed it in slow motion, and reported to the patient that one of the causes of her Achilles tendonitis maybe a restricted range of motion through her lower calf muscle. She was advised that the shock wave therapy would be beneficial for her treatment but that the tightness through her lower calf muscles needed to be addressed also. She was advised to cease the eccentric loading exercises as these were affecting her pain levels and potentially overloading the tendons and that they were already acute and irritated. No other biomechanical anomalies were relevant. Stretching advice was given.

Shockwave Therapy Treatment – Achilles Tendonitis

The sports podiatrist carried out shockwave therapy for the Achilles tendonitis on the left ankle. The machine was set to 2000 repetitions 5 HZ and 1.5 bar of pressure. The treatment lasted for approximately 3 minutes and was well tolerated. As to be expected with Achilles tendonitis the tenderness from treatment was very short lived and the analgesic effect took place quite quickly. Following the treatment with the shockwave therapy machine, the patient was able to walk around the room with minimal pain. She reported to the sports podiatrist that the tendon felt loose and warm.

Shockwave Therapy Number 2 – One Week Later

The patient returned for shockwave therapy of her Achilles tendonitis approximately one week later. Once again the machine was set 2000 reps and 1.5 bar of pressure at 5 HZ. During this session the podiatrist was able to increase the pressure to 2 bars. The patient tolerated the treatment and once again reported instant benefits.

It should be noted that during the treatment program the patient was advised to continue her normal running routine. She was advised that her running routine would be changed if she failed to respond to the treatment.

The patient reported approximately 10% improvement in her condition following the first session of shockwave therapy. The treatment carried on in this fashion for 6 weeks, and the patient received 6 sessions of shock wave therapy in total. After this final session of shock wave therapy, the patient reported approximately 80% improvement in her condition and described to the sports podiatrist that in the mornings when getting out of bed she experienced no further symptoms. She had been continuing to maintain her normal running style and routine. The podiatrist informed the patient that her Achilles tendonitis would continue to improve, although the shockwave therapy had ceased. The patient was informed that the revascularization and the increase in blood flow would promote healing in the coming weeks and that her pain level should continue to drop.

The sports podiatrist arranged a follow up in a further 6 weeks. The patient returned for the 6 week follow up and reported to the podiatrist that the pain from her Achilles tendonitis had completely subsided and that she did not require any additional shock wave therapy.

Please be advised that the information contained in this case study is specific to one particular patient. If you have Achilles tendonitis or if you think you need shockwave therapy please consult with a suitably qualified sports podiatrist.

Karl Lockett
Podiatrist