Hi Pod-Arena. I hope you can advise me on treatment for recalcitrant tendoachilles enthesopathy.
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Patient is a 50 yoa female. Fairly sedentary. There is a ~1 year Hx of pain in the tendon of the Achilles complex. Over time she has had orthotics, shoe heel height advice and a stretching program. Her improvement was moderate.
Patient went to a sports med doctor and had 1 x prp injection, a strengthening program, ECSwT and 2 x cortisone injections. It is now 12 months on from this . Her pain in the tendon is gone but she has developed a large bump at the Haglund's location. She is of the opinion that this developed fairly rapidly after the shockwave treatment. This bony area is now more painful than the original site. We were going reasonably well with a protocol of taping / heel raise / orthotics and no strengthening work to get the area settled down but unfortunately she has had a (really nasty) tape reaction stopping that part of the treatment. Pain is starting to escalate.
Might the bony proliferation be due to the shockwave therapy?
Have other patients' symptoms worsened after treatment?
Is the use of anti-inflammatory substances contraindicated with shockwave therapy?
If surgery was ultimately required, would you choose a z plasty over a chilectomy?
What should I try for her next?
Thanks for any input! Stephanie
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