An update on current concepts and management of mid-substance Achilles tendinopathy

The management of MAT is fundamentally staged, beginning with a prolonged trial of eccentric exercises. HVIGI and ESWT are valuable next-step options. Surgery is considered for refractory cases, with a trend towards minimally invasive techniques owing to their lower complication profile. However, there is a paucity of randomized controlled trials, making surgeon preference and expertise a significant factor in choice of procedure. An evidence-based treatment algorithm is proposed to guide clinical decision-making.