Quick answer
Persistent symptoms after a reasonable rehabilitation period should prompt reassessment of diagnosis, tendon location, loading dose, adherence, strength deficits and competing pathology before another intervention is added.
Article
Was the diagnosis correct?
Pain at the back of the ankle can arise from insertional disease, partial tear, bursitis, plantaris-related symptoms, posterior ankle pathology, inflammatory disease or referred pain. Imaging may become more useful when the clinical course is atypical.
Was rehabilitation actually progressive?
“I did exercises” can mean many things. The program may have been too painful, too easy, too short, poorly progressed or mismatched to insertional compression. The tendon also needs preparation for the patient’s real-world loads.
When adjuncts enter the discussion
Shockwave or injection treatments can be considered in selected cases, but the rationale, evidence, uncertainty and risks should be explained. An intervention should have a defined role within the broader rehabilitation plan.
Key points
- Persistent symptoms are a reason to reassess, not automatically to operate.
- Imaging can be useful when it will change management.
- Adjunctive treatments should have a clear objective and follow-up plan.
Frequently Asked Questions
How long should I try rehabilitation first?
There is no single cut-off, but chronic tendinopathy usually deserves a structured, progressive program over months before invasive treatment is considered, unless other pathology changes the plan.
Does failure of eccentric exercises mean I need surgery?
No. The diagnosis, exercise selection, progression and other options should be reviewed first.