SWAAT Study: Extracorporeal Shock Wave Therapy and Arginine Supplementation and Other Nutraceuticals for Insertional Achilles Tendinopathy

Extracorporeal shockwave therapy (ESWT) produces good results in the treatment of insertional Achilles tendinopathy. The efficacy of combined administration of dietary supplements with ESWT has not yet been studied. In this prospective, randomized clinical trial, Shock Waves therapy and Arginine for Achilles Tendinopathy (SWAAT), subjects affected by insertional Achilles tendinopathy were enrolled. Between January and October 2011, all participants underwent three sessions of ESWT. In addition, the patients in the experimental group received a daily dietary supplement containing arginine, Vinitrox (Bio Serae Laboratories SAS, Bram, France), collagen, methyl-sulfonyl-methane, vitamin C, and bromelain, while the control group patients received placebo. There was no statistically significant difference in the visual analog scale (VAS) score between the two groups at 2 months (3.9 vs. 5.1; P = 0.07), whereas at 6 months the value was significantly lower in the experimental group (2.0 vs. 2.9; P = 0.04). The difference in the Ankle-Hindfoot Scale score at 2 and 6 months of follow-up (FU) was significantly in favor of the experimental group (2 months: 85.4 vs. 72.1; P = 0.0035; 6 months: 92.4 vs. 76.5; P = 0.0002). The Roles and Maudsley score also showed a statistically significant difference between the two groups in favor of the experimental arm as regards patient satisfaction (at 2 months: 1.7 vs. 2.8; P < 0.0001; at 6 months: 1.5 vs. 2.3; P < 0.001). There was a statistically significant reduction in tissue oximetry values compared to baseline in both treatment groups at 2 and 6 months of FU. Comparing the groups, only at the last FU, at 6 months, was a significantly lower oximetry value observed in the experimental group versus controls (60.2 vs. 66.0; P = 0.007). On the basis of the results obtained in this study, the authors conclude that in the treatment of insertional Achilles tendinopathy, ESWT induces a hemodynamic re-equilibrium with an in tendon trophism. The addition of specific dietary supplements could improve the therapeutic response.