NICE interventional procedure guidance
Issued: August 2009

Extracorporeal shockwave therapy for refractory Achilles tendinopathy

This is an extract from the guidance. The complete guidance is available at

1 Guidance

1.1 The evidence on extracorporeal shockwave therapy (ESWT) for refractory Achilles tendinopathy raises no major safety concerns: there have been reports of occasional tendon rupture in treated patients, but this may also occur when the procedure has not been used. However, current evidence on efficacy of the procedure is inconsistent. Therefore, ESWT for refractory Achilles tendinopathy should only be used with special arrangements for clinical governance, consent and audit or research.

1.2 Clinicians wishing to undertake ESWT for refractory Achilles tendinopathy should take the following actions.

  • Inform the clinical governance leads in their Trusts.

  • Ensure that patients understand the uncertainty about the procedure's efficacy, and about its safety in relation to a possible risk of tendon rupture, and provide them with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended.

  • Audit and review clinical outcomes of all patients having ESWT for refractory Achilles tendinopathy (see section 3.1).

1.3 NICE encourages further research into ESWT for refractory Achilles tendinopathy. Future research should take the form of clinical studies with clearly described patient selection and treatment protocols, including a description of local anaesthesia use and the type of energy applied (see section 2.5). The studies should include validated outcome measures and be based on a minimum of 1-year follow-up. NICE may review the procedure on publication of further evidence.