title: Extracorporeal shockwave therapy (ESWT) for refractory Achilles tendinopathy: A prospective audit with 2-year follow up.
abstract: BACKGROUND
  Achilles tendinopathy (AT) represents a triad of tendon pain, swelling and impaired performance. Extracorporeal shockwave therapy (ESWT) has been endorsed by the National Institute for Health and Care Excellence (NICE) for refractory AT. This audit investigates the long-term outcomes of patients treated with ESWT for refractory AT.
  
  
  METHODS
  Forty-six patients treated with ESWT for AT between October 2010 and August 2011 completed visual analogue, satisfaction scores and functional assessment questionnaires over two years. Patients were subdivided into two groups depending on whether their AT was insertional (IAT) or non-insertional (NAT).
  
  
  RESULTS
  Forty-six patients (mean age 58 years) completed all treatments and full 2 year follow up. There was significant improvement in pain at rest, on activity and of function within both NAT and IAT groups over the two-year period. Satisfaction scores were significant in the NAT group but not in the IAT group.
  
  
  CONCLUSIONS
  ESWT appears to be of benefit in the long term improvement of pain at rest, on activity and functional outcome in patients with refractory AT. However, subjective patient opinion may not match the perceived clinical outcome observed in this audit in all patients and individuals should be counselled regarding this prior to treatment.
authors.affiliation: Department of Radiology, Royal Devon and Exeter Hospital, Exeter, UK. Electronic address: james.taylor22@nhs.net.
authors.forename: James
authors.initials: J
authors.lastname: Taylor
authors.affiliation: Department of Orthopaedic Surgery, Royal Devon and Exeter Hospital, Exeter, UK. Electronic address: sdunkerley@doctors.org.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dunkerley
authors.affiliation: Department of Radiology, Royal Devon and Exeter Hospital, Exeter, UK. Electronic address: davidsilver@nhs.net.
authors.forename: David
authors.initials: D
authors.lastname: Silver
authors.affiliation: Department of Radiology, Royal Devon and Exeter Hospital, Exeter, UK. Electronic address: andrewredfern@nhs.net.
authors.forename: Andrew
authors.initials: A
authors.lastname: Redfern
authors.affiliation: Department of Orthopaedic Surgery, Royal Devon and Exeter Hospital, Exeter, UK. Electronic address: nick.talbot@nhs.net.
authors.forename: Nick
authors.initials: N
authors.lastname: Talbot
authors.affiliation: Department of Orthopaedic Surgery, Royal Devon and Exeter Hospital, Exeter, UK. Electronic address: iansharpe@nhs.net.
authors.forename: Ian
authors.initials: I
authors.lastname: Sharpe
authors.affiliation: Department of Orthopaedic Surgery, Royal Devon and Exeter Hospital, Exeter, UK. Electronic address: paul.guyver@nhs.net.
authors.forename: Paul
authors.initials: P
authors.lastname: Guyver
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D019220:High-Energy Shock Waves / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D052256:Tendinopathy / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Achilles tendon; Conservative management; ESWL (extracorporeal shockwave lithotripsy); ESWT (extracorporeal shockwave treatment); Tendinopathy