Injections Fail to Benefit Achilles Tendinopathy
A new clinical trial finds that high-volume injections offer no long-term improvement for patients with Achilles tendon pain.
Updated on Oct. 29, 2026 in Arthritis
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A randomized trial of 192 patients shows that high-volume injections, including those with corticosteroids, provide no lasting relief for Achilles tendinopathy. While some early benefits were observed at six weeks, these effects disappeared within three months.
Why it matters
The study suggests that common injection-based treatments for chronic tendon pain may be ineffective in the long run. Notably, the inclusion of corticosteroids was associated with increased patient pain and disability at 26 weeks.
The study randomized 192 participants into three groups to evaluate bupivacaine, hydrocortisone, or sham injections. Researchers observed aggravated Achilles pain in 28% of the sham group, 25% of the steroid group, and 16% of the bupivacaine group.
The details
Patients received injections at the junction of the Achilles tendon and Kager's fat pad, while sham treatments were administered at least 10 mm away from this area. Although the steroid-based group reported improved outcomes on the VISA-A disability scale at six weeks, those advantages were non-existent by the 12-week mark.
Timeline
Improved outcomes for the steroid group were recorded at 6 weeks.
Short-term treatment advantages vanished by 12 weeks.
Patients in the steroid group experienced worse pain and disability at 26 weeks.
Primary outcome assessments concluded at 52 weeks.
The Big Picture
This study uses the VISA-A pain and disability scale to evaluate recovery, extending clinical efforts to standardize outcomes for tendon health. The results mark a departure from the historical clinical reliance on corticosteroid injections for managing chronic tendon inflammation.
Patients suffering from Achilles tendinopathy should discuss these findings with their orthopedic providers when considering injection-based therapies. The study highlights that common interventions may fail to provide long-term relief and could potentially exacerbate disability.
The takeaway
Clinicians and patients should be cautious regarding the long-term reliance on corticosteroid injections for tendon pain management. Focusing on alternative physical rehabilitation strategies may prove more effective given the lack of sustained benefit observed in this trial.
Further reading
For more information on the management of chronic joint and tendon conditions, see the Arthritis section.
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