Ultrasound-Guided Cortisone Injections for Achilles Tendinopathy

 

Introduction

Achilles tendinopathy is a common condition that affects the Achilles tendon, the largest and strongest tendon in the body. It typically develops due to overuse, repetitive stress, or degenerative changes, leading to pain, stiffness, and reduced function. Achilles tendinopathy is particularly common in athletes, runners, and individuals who engage in high-impact activities, but it can also occur in those with poor biomechanics or sudden increases in physical activity.

This condition can significantly impact mobility, making everyday activities such as walking, climbing stairs, and standing for long periods difficult. While conservative management, including physiotherapy, stretching, and footwear modification, is often the first approach, persistent cases may require additional intervention.

Ultrasound-guided cortisone injections may be considered for certain cases to help manage symptoms by reducing inflammation and pain. This blog will explore the anatomy, pathology, causes, symptoms, diagnosis, and treatment of Achilles tendinopathy, with a focus on how cortisone injections work and their role in treatment.

Achilles Tendinopathy

Anatomy of the Achilles Tendon

The Achilles tendon is a strong fibrous structure that connects the gastrocnemius and soleus muscles of the calf to the calcaneus (heel bone). It plays a vital role in:

✔ Plantarflexion of the foot — Essential for walking, running, and jumping.
✔ Absorbing and transmitting forces during weight-bearing activities.
✔ Stabilising the ankle and foot during movement.

The Achilles tendon is divided into two key regions:

  1. Mid-portion (Non-insertional Achilles Tendinopathy) — The most common site of tendinopathy, typically 2–6 cm above the heel.
  2. Insertional Achilles Tendinopathy — Affects the area where the tendon inserts into the heel bone.

Unlike other tendons, the Achilles tendon has a poor blood supply, particularly in its mid-portion. This limited vascularity makes it more susceptible to degeneration and slow healing.

Pathology of Achilles Tendinopathy

Achilles tendinopathy is primarily a degenerative condition, rather than a purely inflammatory one. Repetitive stress leads to microtears, collagen breakdown, and structural disorganisation within the tendon.

Key pathological changes include:
✔ Collagen disarray — The normal, parallel structure of collagen fibres becomes disrupted.
✔ Neovascularisation — Formation of abnormal small blood vessels within the tendon.
✔ Thickening and swelling — Due to persistent stress and failed healing response.
✔ Degeneration of tendon fibres — Leading to reduced strength and elasticity.

Over time, these structural changes can result in chronic pain, stiffness, and loss of function, particularly during activities that place strain on the Achilles tendon.

Causes of Achilles Tendinopathy

1. Overuse and Repetitive Strain

  • Common in runners, athletes, and individuals who engage in frequent jumping or sprinting.
  • Sudden increases in training intensity, duration, or frequency can contribute to tendon damage.

2. Poor Foot Biomechanics

  • Flat feet (pes planus) or high arches (pes cavus) can alter force distribution, increasing stress on the Achilles tendon.
  • Abnormal gait patterns may lead to excessive strain and irritation.

3. Tight Calf Muscles

  • Stiffness in the gastrocnemius and soleus muscles increases tension on the Achilles tendon, predisposing it to injury.

4. Improper Footwear

  • Worn-out shoes, high heels, or lack of proper arch support can lead to excessive strain.

5. Sudden Changes in Activity Levels

  • Going from a sedentary lifestyle to intense exercise without proper conditioning.

6. Age-Related Degeneration

  • Common in individuals over 40 years old, as the Achilles tendon loses elasticity and repair capacity.

Symptoms of Achilles Tendinopathy

✔ Pain and stiffness in the Achilles tendon, especially in the morning or after periods of rest.
✔ Swelling and tenderness along the back of the ankle.
✔ Pain that worsens with activity, such as running, jumping, or climbing stairs.
✔ Thickening of the tendon over time due to chronic stress.
✔ Reduced strength and flexibility in the ankle.

Diagnosis of Achilles Tendinopathy

Clinical Assessment at Alton Pain Clinic

A clinician will conduct a comprehensive evaluation, including:
✔ Patient history — Identifying activity levels, risk factors, and symptom patterns.
✔ Physical examination — Assessing tendon tenderness, swelling, and functional limitations.

Imaging Studies

  1. Ultrasound Scan — Identifies thickening, structural changes, and neovascularisation within the tendon.
  2. MRI Scan — Used in severe or chronic cases to assess degenerative changes.

Treatment Options for Achilles Tendinopathy

Conservative Management

✔ Activity modification — Reducing activities that place excessive strain on the tendon.
✔ Stretching and strengthening exercises — Particularly eccentric loading exercises to improve tendon health.
✔ Orthotics and footwear modifications — Custom insoles to improve foot biomechanics.
✔ Pain relief strategies — Including NSAIDs and cold therapy.

Ultrasound-Guided Cortisone Injections for Achilles Tendinopathy

For persistent pain and inflammation, ultrasound-guided cortisone injections may be considered to help reduce symptoms and improve function.

Mechanism of Action of Cortisone Injections

Cortisone injections work by:
✔ Suppressing inflammation — Inhibiting inflammatory mediators that contribute to pain.
✔ Reducing swelling — Helping to decrease tendon irritation.
✔ Providing temporary symptom relief — Allowing patients to engage in rehabilitation.

Why Use Ultrasound Guidance?

At Alton Pain Clinic, ultrasound guidance ensures:
✔ Accurate placement of the injection at the affected tendon site.
✔ Minimisation of risks, such as unintentional damage to surrounding structures.
✔ Improved precision, leading to better symptom control.

Procedure Overview

  1. Preparation — The clinician cleans the area and applies a local anaesthetic.
  2. Ultrasound Guidance — Ensures precise delivery of the medication.
  3. Cortisone Injection — The corticosteroid is administered near the affected tendon.
  4. Post-Injection Care — Patients are advised to avoid high-impact activities temporarily.

Why Choose Alton Pain Clinic for Achilles Tendinopathy Treatment?

✔ Expert clinicians with extensive experience in musculoskeletal conditions.
✔ Advanced ultrasound-guided injection techniques for precision treatment.
✔ Personalised care tailored to each patient’s specific needs.

Conclusion

Achilles tendinopathy is a challenging condition that can significantly impact mobility and daily activities. While conservative measures are the first line of treatment, ultrasound-guided cortisone injections may help manage symptoms in persistent cases.

At Alton Pain Clinic, we provide expert musculoskeletal care with ultrasound-guided precision treatments to ensure optimal patient outcomes.

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