🦶 Case Study: Focused ESWT for Scar Tissue & Insertional Achilles Tendinopathy
Restoring Function After Four Ankle Surgeries in a Retired Professional Footballer
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Patient Profile
- Age: 35
- Occupation: Retired professional footballer
- Referral: Via employer (private sector)
- History:
- 4 ankle operations (Achilles, TFL, ankle joint)
- Significant post-surgical scar tissue build-up
- Ongoing Achilles insertional tendinopathy
- Chronic Flexor Hallucis Longus (FHL) irritation
- No running for 3 years due to mechanical restrictions and pain
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Presenting Complaint
- “Tight, hard, lumpy” scar tissue restricting Achilles glide and spring
- FHL inflamed and reactive to push-off
- Calf (Soleus) stiffness and deep fibrosis due to crutch use and post-op immobilisation
- Marked decline in lower limb function, performance, and psychological confidence
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Treatment Focus: Focused Extracorporeal Shockwave Therapy (ESWT)
- Targeted Focused ESWT was applied over:
- Insertional Achilles
- Posterior ankle scar planes
- TFL surgical adhesion zones
- FHL tendon sheath
- Soleus fascia and deep posterior compartment
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Backed by the Literature
From Magnusson et al. (2010):
“Tendons are not inert. They are metabolically active and responsive to mechanical loading. Scar tissue hydration and reorganisation require a balance between collagen breakdown and new synthesis.”
ESWT plays a key role in restarting this process, particularly where surgical trauma has disrupted it.
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Outcome After 3 Sessions
- Ran 4km x2 while on holiday — his first runs in over 3 years
- Marked reduction in tissue density and stiffness
- Improved spring and recoil in Achilles and FHL
- Less reactive, more mobile scar beds
- Progressed to Smith machine rehab with physio guidance
- Described the experience as:
“Game-changing. Life-changing. I can run again.”
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Clinical Insight
Scar tissue from repeated surgeries often leads to mechanical restriction, altered tendon loading, and secondary overuse of adjacent structures like the FHL.
Focused ESWT, when timed with intelligent progressive loading, facilitates scar remodelling and reactivates tendon tissue that has remained metabolically dormant.
