A Pathophysiology-Based Four-Stage Ultrasound-Guided Acupuncture Strategy for Chronic Achilles Tendinopathy: A Case Report (CARE Compliant)

Introduction: Achilles tendinopathy is a common musculoskeletal condition that significantly impairs gait and overall mobility, ultimately reducing the quality of life. It is characterized by activity-induced pain, swelling, and functional limitations, and is often caused by repetitive microtrauma, increased mechanical load, or reduced vascular supply. Without appropriate treatment, abnormal gait patterns such as medial collapse may occur, leading to long-term biomechanical imbalances. Despite available conservative and surgical options, no clear consensus exists regarding optimal management, and many patients fail to respond adequately. These limitations highlight the need for novel pathophysiology-based therapeutic approaches.Case Presentation: A 49-year-old restaurant worker experienced chronic left heel pain for five years and was diagnosed with chronic Achilles tendinopathy accompanied by calcific tendinitis. Previous treatments, including nine triamcinolone-lidocaine injections and ten platelet-rich plasma sessions, resulted in minimal improvement, and surgical intervention was recommended. She received a total of 12 treatment sessions over a 47-day period. The patient underwent a four-stage ultrasound-guided acupuncture protocol. The protocol included the following: (1) management of paratenonitis, (2) fascial release between the gastrocnemius and soleus muscles using pharmacopuncture, (3) removal of neovascularization via high-volume injection, and (4) periosteal pecking technique (also called dry needling, and referred to as Golmak-Jaktak-beop in traditional Korean medicine) and high-frequency electroacupuncture targeting the Achilles tendon insertion. Post-treatment color Doppler ultrasonography showed reduced intratendinous neovascularization. The patient’s Foot and Ankle Outcome Score (FAOS) subscales demonstrated consistent improvement throughout treatment and at the two-month follow-up.Conclusion: This case suggests that a four-stage ultrasound-guided acupuncture approach may be a potential nonsurgical treatment option for chronic Achilles tendinopathy, especially in patients unresponsive to conventional therapies.