This research sought to influence clinical management and treatment of Achilles tendinopathy by: 1) evaluating the efficacy of sclerotherapy (with a 25% dextrose and 0.5% lidocaine sclerosant) over the course of one year; 2) evaluating the effectiveness of a 12 week standardized home based heavy load eccentric training program; and 3) describing the prevalence of neovascularisation in adults with disease and without, and prevalence after treatment. Specifically, it provides the first short term data from a prospective triple blinded randomized controlled trial on the efficacy of ultrasound guided sclerosing 25% dextrose and 0.5% lidocaine injections following failure of eccentric exercises. Sclerotherapy was an efficacious treatment in the short term (3 months) with all patients showing statistically significant improvement in pain and function (as measured by the Victorian Institute of Sport Assessment-Achilles outcome measure), but its positive effects decreased for some patients after one year. With regards to neovascularisation, it was present in all affected tendons (and in one individual without the disease), but change in the number of neovessels does not appear to affect symptoms. With regard to eccentric training, it was found to not be effective in the majority of patients with only two patients considering themselves satisfied with treatment. Based on these results, a treatment paradigm and future research directions are provided. Most notably, eccentric training is not recommended as an effective treatment option for Achilles tendinopathy. Sclerotherapy is recommended as a treatment option for both mid-portion and enthesopathy.
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