Efficacy of Radial Extracorporeal Shockwave Therapy for Insertional Achilles Tendinopathy | Literature Review | Find Your Stride | Edinburgh Podiatrist

Introduction

In the realm of sports medicine and rehabilitation, the treatment of insertional Achilles tendinopathy presents a significant challenge. A randomised controlled trial (RCT) titled "Does shockwave therapy lead to better pain and function than sham over 12 weeks in people with insertional Achilles tendinopathy?" conducted by Alsulaimani et al. (2025) attempts to shed some light on the efficacy of radial extracorporeal shockwave therapy (rESWT) compared to a sham treatment. While the study provides valuable insights, it also highlights the complexities surrounding treatment effectiveness and the necessity of adequate methodological rigor.

Insertional Achilles tendinopathy causes pain where the Achilles tendon attaches to the heel bone (calcaneus)

Overview

The study's aim was to assess whether rESWT combined with a structured exercise regimen could confer additional benefits to individuals suffering from insertional Achilles tendinopathy, a condition often associated with debilitating pain and functionality issues. It enrolled 76 participants, who were randomised to receive either rESWT or a sham treatment, and outcomes were measured at baseline, six weeks, and twelve weeks using the Victorian Institute of Sports Assessment – Achilles (VISA-A) questionnaire.

Findings and Implications

Despite the anticipation surrounding rESWT, findings revealed no significant differences in pain and function between the rESWT and sham groups at either six or twelve weeks. This outcome raises some questions about the true efficacy of rESWT, suggesting that the perceived benefits may largely stem from a placebo effect rather than the treatment itself.

The implications of this finding are considerable. Clinicians often seek novel, non-invasive treatments for chronic conditions like Achilles tendinopathy, and rESWT seemed to offer a promising option. However, this study indicates that practitioners should remain cautious. The results evoke skepticism regarding the legitimacy of non-invasive shockwave therapies and encourage a critical re-evaluation of alternative treatment options.

Limitations of the Study

The authors candidly acknowledge several limitations. For instance, participants in the sham group experienced notable discomfort during treatment, which could affect their overall response and skew results. The lack of blinding for physiotherapists administering the treatments raises concerns of bias, while uncertainty in the actual energy dose delivered may undermine the validity of the findings.

Moreover, the study suggests that the positive outcomes may align more closely with the psychological impacts of treatment rather than with physiological changes caused by rESWT itself. This is an important consideration and provides a valuable perspective on the understanding of treatment effects.

Conclusion

This review of the study highlights the ongoing debate surrounding the effectiveness of shockwave therapy, specifically for insertional Achilles tendinopathy. While the trial contributes to the existing literature, it underscores the necessity for rigorous study designs that effectively address biases and methodological shortcomings. Future research should strive to establish more effective sham treatment protocols, employ blinding mechanisms for all parties involved, and clarify the dosages required for potential therapeutic effects.

In summary, while rESWT still offers a glimmer of hope for individuals grappling with chronic tendon pain, this study serves as a timely reminder of the complexities inherent in managing such conditions. Clinicians and researchers alike must continue to seek rigorous evidence to inform best practices and guide effective treatment approaches for patients experiencing the challenges of insertional Achilles tendinopathy.

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