High volume injections Achilles tendon

Achilles tendon high volume injections

A High-Volume Injection (HVI) is a specialised ultrasound-guided procedure used to treat chronic mid-portion or insertional Achilles tendinopathy.

It involves injecting a carefully measured combination of saline and local anaesthetic around the Achilles tendon — particularly in the space between the tendon and the inflamed fat pad (Kager’s fat pad).

The aim is to reduce pain by disrupting painful nerve ingrowth and reducing irritation around the tendon.

Why High-Volume Injection Works

Chronic Achilles tendinopathy often involves:

  • Thickening of the tendon

  • Increased blood vessel growth

  • Nerve fibres growing into the tendon, which contribute to pain

  • Irritation between the tendon and the surrounding tissues

A high-volume injection helps by:

  • Flushing out painful nerve fibres from around the tendon

  • Reducing friction and irritation

  • Providing pain relief, allowing more effective rehabilitation

  • Improving tolerance for walking, running, and loading exercises

HVI does not weaken the tendon, and when combined with a structured strengthening programme, it can significantly improve long-term recovery.

Who Is a High-Volume Injection Suitable For?

This treatment is appropriate for people with:

  • Persistent Achilles tendinopathy lasting more than 3 months

  • Pain that has not improved with exercise therapy alone

  • Painful swelling or thickening of the tendon

  • Reduced running capacity or persistent morning stiffness

  • Imaging signs of neovascularisation (seen clearly on ultrasound)

It is commonly used for active individuals, runners, or anyone with long-standing symptoms.

What Happens During the Procedure?

The injection includes:

  • Local anaesthetic

  • A large volume of saline solution

  • Sometimes a small amount of corticosteroid around (not into) the tendon if there is significant surrounding inflammation

Under ultrasound guidance, the solution is injected into the interface around the tendon, gently separating irritated tissues and reducing nerve-related pain.

Most patients feel a sense of pressure rather than pain during the procedure.

Why Ultrasound Guidance Is Essential

High-volume injections must be placed with precision—incorrect placement reduces effectiveness and increases risk. Ultrasound ensures:

  • Exact positioning outside the tendon (never into the tendon fibres)

  • Safe separation of the tendon and fat pad

  • Clear identification of nerves, vessels, and abnormal tissue

  • A smoother, more comfortable procedure

  • Better clinical outcomes

Ultrasound guidance is considered best practice for all high-volume Achilles injections.