PM&R Meeting Abstracts

Official abstracts site for the AAPM&R Annual Assembly and the PM&R Journal.

MENU 
  • Home
  • Meetings Archive
    • AAPM&R Annual Assembly 2022
    • AAPM&R Annual Assembly 2021
    • AAPM&R Annual Assembly 2020
    • AAPM&R Annual Assembly 2019
  • Resources
  • Advanced Search

Acute on Chronic Posterior Ankle Pain Refractory to Eccentrics in a Marathon Runner: A Case Report

David Oh, MD (Temple University Hospital/Moss Rehab, Philadelphia, Pennsylvania); Anton Matveev, MD; Tunc C. Kiymaz, MD; Reed C. Williams, MD, MBS, RMSK, FAAPMR

Meeting: AAPM&R Annual Assembly 2020

Categories: Musculoskeletal and Sports Medicine (2020)

Session Information

Session Title: Virtual Poster Hall

Session Time: None. Available on demand.

Disclosures: David Oh, MD: No financial relationships or conflicts of interest

Case Description: A marathon runner previously treated with eccentric based therapy protocols, activity modification, NSAIDs, and AirHeel orthoses presented with left worse than right posterior ankle pain. Notably, he was prescribed levofloxacin for a sinus infection 1-2 weeks prior to symptom onset. There was left greater than right swelling of the Achilles tendon with tenderness to palpation on the left. Ankle ROM was full and without crepitus, but painful with plantarflexion bilaterally. A diagnostic ultrasound was consistent with left worse than right Achilles tendinosis with midportion hypertrophy and echogenic changes, a small retrocalcaneal bursopathy on the left, and neovessel invagination from Kager’s fat pad into the Achilles tendon bilaterally on Doppler visualization. After discussion of treatment options, he underwent US-guided percutaneous tendon scraping and neovessel ablation of the left Achilles tendon with peritendinous cortisone injection.

Setting: Outpatient

Patient: 30-year-old man with six-week history of bilateral ankle pain Assessment/

Results: Patient had immediate post-procedural pain relief with maintained strength. At 10-day follow-up, he reported 100% pain relief on the left following resumption of all ADL’s, demonstrated progress with re-initiation of eccentric based therapy program, and gradually increased symptom-free running to a 7-mile distance. Repeat diagnostic US showed interval healing of left Achilles tendon with improvement in tendon hypertrophy and intrasubstance fiber echogenicity, along with ablation of neovascularity and nascent vessel fat pad-tendon cross bridging.

Discussion: Interventional approaches for disruption of neovascularization in Achilles tendinopathy vary by injectate and arthroscopic or ultrasound guidance. The procedure attempts to decrease chronic irritation and promote tendinous healing by destroying aberrant vessels crossing from Kager’s fat pad into the Achilles tendon. This inhibits anchoring and limits avenues for proinflammatory effector recruitment.

Conclusion: Ultrasound-guided percutaneous neovessel ablation with cortisone infusion is a viable minimally invasive treatment option for chronic Achilles tendinopathy with sonographic evidence of neovascularization.

Level of Evidence: Level V

To cite this abstract in AMA style:

Oh D, Matveev A, Kiymaz TC, Williams RC. Acute on Chronic Posterior Ankle Pain Refractory to Eccentrics in a Marathon Runner: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/acute-on-chronic-posterior-ankle-pain-refractory-to-eccentrics-in-a-marathon-runner-a-case-report/. Accessed May 8, 2025.
  • Tweet
  • Email
  • Print

« Back to AAPM&R Annual Assembly 2020

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-on-chronic-posterior-ankle-pain-refractory-to-eccentrics-in-a-marathon-runner-a-case-report/

Leading the Way. Baltimore, MD & Virtual. October 20-23, 2022. #aapmr22

PM&R Journal

View issues of PM&R on the Wiley Online Library »

American Academy of Physical Medicine and Rehabilitation

Visit the official site for the American Academy of Physical Medicine and Rehabilitation »

AAPM&R Annual Assembly

Visit the official site for the AAPM&R Annual Assembly »

  • Help & Support
  • About Us
  • Cookies & Privacy
  • Wiley Job Network
  • Terms & Conditions
  • Advertisers & Agents
Copyright © 2025 John Wiley & Sons, Inc. All Rights Reserved.
Wiley