A 34-year-old recreational runner has 3 months of pain in the middle portion of the Achilles tendon, worse after running. There is fusiform thickening of the tendon 4 cm above its insertion, no gap, and a negative Thompson test. Initial management should be:
- A Eccentric calf muscle loading exercises ✓
- B Local corticosteroid injection into the tendon
- C Surgical debridement of the tendon
- D Complete immobilisation in a cast for 8 weeks
Explanation
Midportion (noninsertional) Achilles tendinopathy responds to eccentric calf loading protocols, heavy slow resistance training, and activity modification as first-line therapy. Corticosteroid injection into the tendon is avoided because of the risk of rupture, a classic examination trap. Surgery is considered only after failure of prolonged conservative treatment. Complete cast immobilisation is unnecessary and leads to stiffness and weakness, being reserved for acute rupture or severe refractory cases. The thickened but intact tendon with a negative Thompson test excludes rupture.
Reference: Campbell's Operative Orthopaedics, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.