Effectiveness of Reducing Tendon Compression in the Treatment of Insertional Achilles Tendinopathy (GhenTendon)

Ghent University Hospital (UZ)

Status

Completed

Conditions

Insertional Achilles Tendinopathy

Treatments

Other: Exercise therapy

Other: Exercise therapy (usual care)

Study type

Interventional

Funder types

Other

Identifiers

NCT05456620

BC-11818

Details and patient eligibility

About

Insertional Achilles tendinopathy is a disabling injury that is common in running athletes. Exercise therapy is considered the best treatment option, but there is still no agreement on the modalities. For example, it is thought that compression overload may be a major cause of tendinopathy and should therefore be restricted during rehabilitation. However, this recommendation is based on expert opinion and not on hard scientific evidence. Therefore, this randomised controlled trial (RCT) will investigate whether a therapy that limits the amount of compression of the tendon during a progressive tendon-loading rehabilitation protocol actually has better outcomes in athletes with insertional Achilles tendinopathy.

Athletes with insertional Achilles tendinopathy will be randomised into two treatment groups; (1) an experimental rehabilitation protocol in which the amount of tendon compression is limited and (2) a control rehabilitation protocol in which the amount of tendon compression is not limited and is rather high. Both treatments consist of supervised progressive tendon-loading exercise therapy and patient education. In addition, the experimental group will also receive heel inserts to limit the amount of dorsiflexion during sports or daily activities. At baseline, at 12 weeks (end of intervention) and at 24 weeks (follow-up), pain, functionality, structure and intratendinous pressure will be determined.

Full description

Achilles tendinopathy is a debilitating injury that is common among athletes, especially those involved in running sports. Around 30% of all runners exhibit Achilles tendinopathy with an annual incidence of 7-9%. Of these patients, roughly one-third will have insertional Achilles tendinopathy (IAT). Several mechanisms are considered to play a role in the aetiology of Achilles tendinopathy, yet a prominent role seems present for excessive overload. Traditionally, the nature of this overload is thought to be purely tensile. However, the Achilles tendon can also be exposed to compressive loads at the insertion when the tendon wraps around the posterior prominence of the calcaneus during dorsiflexion of the ankle. The formation of fibrocartilage-like tissue, which is typically found in histological examination of tendinopathy, can be considered as an adaptation to this compressive load, driven by the tenocyte's mechanotransduction process. Therefore, it is recommended to reduce the amount of compressive load on the tendon during rehabilitation while exerting sufficient tensile load. However, these recommendations are mainly based on a pilot study and expert opinion. Therefore, this RCT investigates whether a therapy in which the amount of tendon compression is restricted during a progressive tendon-loading rehabilitation protocol actually has better outcomes in terms of pain scores, functionality and structure of the Achilles tendon in athletes with insertional Achilles tendinopathy. Limiting the amount of tendon compression on the Achilles tendon insertion will be achieved by (1) patient education, (2) heel inserts and (3) an adapted exercise regimen.

Enrollment

42 patients

Sex

All

Ages

18 to 60 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Age 18-60 years old
Diagnosed with insertional Achilles Tendinopathy by a sports medicine physician
Have experienced symptoms for more than 3 months but less than 3 years
A severity level of less than 80 points on the VISA-A score
Playing running-based sports at least twice a week
Able to comply with both exercise programs

Exclusion criteria

Have a history of Achilles tendon rupture or surgery
Have other disorders of the Achilles tendon or ankle (mid-portional Achilles tendinopathy, paratenonitis, osteoarthritis,...)
Have rheumatological disorder (e.g. Spondylitis Ankylosis)
Have metabolic or endocrine disorders, such as type I or type II diabetes
Have had an Achilles injection in the past 3 months
Have other conditions that prevent following an active exercise programme
Have already been treated with physiotherapy, shockwave therapy or orthotics in the past 3 months
Medication use with (fluoro)quinolones antibiotic in the past 2 years
Currently pregnant