Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision – 2024

This 2024 revision of the APTA Orthopaedic academy guideline on midportion Achilles tendinopathy was published in JOSPT. It covers risk factors, diagnosis (noting that imaging is not needed to make the diagnosis but has a role when it is uncertain or care is not working), examination and physical therapy treatment.

Its central recommendation is tendon-loading exercise, progressed to loads as high as tolerated, as the first-line treatment, paired with education about the condition. Patients are advised to stay active within pain tolerance rather than rest completely.

Heel lifts, elastic or rigid taping, manual therapy to muscles and joints, and dry needling of the calf muscles are presented as optional additions in certain situations. The guideline advises against low-level laser and against therapeutic ultrasound used alone, and makes no recommendation on orthoses because the evidence conflicts.