Chronic Resistant Achilles Tendinopathy

Quick answer

Achilles tendinopathy most often responds to rehabilitation, shock waves and rest. When pain persists despite these treatments, embolization of the feeding branches of the tendon, targeting pathological neovascularisation, is a minimally invasive option.

A common condition, sometimes stubborn

Achilles tendinopathy frequently affects athletes but also sedentary patients. In most cases, it responds to rehabilitation, shock waves and appropriate rest. In some patients, the pain persists despite these well-conducted treatments.

The mechanism of chronic pain

In chronic resistant tendinopathies, pathological peritendinous neovascularisation can sustain inflammation and pain. This is the mechanism targeted by embolization of the feeding branches of the tendon, confirmed beforehand by Doppler ultrasound.

Management at Cochin AP-HP

Embolization of the peroneal arteries or of their peritendinous branches is offered when well-conducted conservative treatments have failed, after confirmation of the neovascularisation on imaging.

Frequently asked questions

How long should rehabilitation last before embolization is considered?

Embolization is offered after failure of well-conducted conservative treatments over a sufficient period. The decision is individualised with the team.

Is the procedure painful?

It is performed under local anaesthesia, like the other joint embolization techniques offered by the department.

Learn more

Inflammatory ankle centre at Cochin AP-HP

Joint and peritendinous embolization, Doppler ultrasound and MRI work-up, alternative to surgery.

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New in the literature: 2026 review of musculoskeletal embolization

A narrative review published in October 2026 in CVIR Endovascular (Pelage JP, Aldalmani T, Geevarghese R, Zhang N, Jegonday MA, Berry G, Dohan A, Fohlen A, Grange S) sorts the indications of musculoskeletal arterial embolization by level of evidence. Hemostatic and selected tumour-related indications are established. Pain-directed embolization, including genicular artery embolization and embolization for tendinopathies, is performed as a stand-alone minimally invasive procedure targeting pathological neovascularity. Evidence remains heterogeneous: the authors stress careful patient selection, standardized outcome assessment and further comparative trials to define durability and clinical value. It covers embolization for chronic tendinopathies, the subject of this page.

Read the review (DOI) → · View on PubMed →

Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.

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Chronic resistant Achilles tendinopathy