musculoskeletal and connective tissue disorders
Achilles Tendon Enthesopathy
Treatment of Achilles Tendon Enthesopathy
Stretching, splinting, and heel lifts If present, treatment of Overview of Seronegative Spondyloarthropathies None Physical therapy is essential for home exercise programs aimed at calf muscle–stretching techniques, which should be done for about 10 minutes 2 to 3 times a day. The patient can exert pressure posteriorly to stretch the calf muscle while facing a wall at arms’ length, with knees extended and foot dorsiflexed by the patient's body weight (standing gastrocnemius stretch). To minimize stress to the Achilles tendon with weight bearing, the patient should move the foot and ankle actively through their range of motion for about 1 minute when rising after extended periods of rest. Night splints may also be prescribed to provide passive stretch during sleep and help prevent contractures. Heel lifts should be used temporarily to decrease tendon stress during weight bearing and relieve pain. Even if the pain is only in one heel, heel lifts should be used bilaterally to prevent gait disturbance and possible secondary (compensatory) hip and or low back pain. For patients with Achilles tendon enthesopathy related to an underlying Overview of Seronegative Spondyloarthropathies , treatment with a nonsteroidal anti-inflammatory drug (NSAID) or a biologic agent (eg, TNF inhibitor) may be beneficial. For more recalcitrant forms of Achilles tendon enthesopathy, extracorporeal pulse activation therapy (EPAT), also known as extracorporeal shockwave therapy (ESWT), may be considered. In EPAT, low-frequency pulse waves are delivered locally using a handheld applicator. The pulsed pressure wave is a safe, noninvasive technique that is thought to stimulate metabolism and enhance blood circulation, which in turn may help regenerate damaged tissue and accelerate healing. Some data have shown improvement in symptoms and functional outcomes with EPAT ( Treatment references ); however, additional high-quality evidence is needed to determine duration and frequency of treatments ( 