Bilateral Calcification of Achilles’ Tendons, and Acetic Acid Iontophoresis Plus Ultrasound Effectivenness

Introduction: Calcifying tendonitis is the deposition of hydroxyapatite within tendons. It could affect different tendons. In the current case report, bilateral Achilles’ tendons were affected. The etiology is multifactorial. The treatment is conservative and surgical. Iontophoresis is a conservative technique that favors the penetration of 5% acetic acid, based on the attraction and repulsion of charges with the help of continuous electric current. Case Presentation: A 57-year-old female presented a 12-month experience of bilateral Achilles’ tendon pain. Conservative treatment (nonsteroidal anti-inflammatory drugs (NSAIDs), laser therapy, and physiotherapy) and advanced treatment (shock waves) did not alleviate her pain. Radiography and ultrasound scan showed bilateral insertional formative calcification on both Achilles’ tendons, 9.3 mm on left Achilles’ tendon and 6.6 mm on right one. After 15 sessions of 5% acetic acid iontophoresis (2 mL, 4.7 mA × 10 minutes) and continuous ultrasound (1 W/cm2,1 MHz × 5 minutes) over the calcification area, calcification sizes decreased from 9.3 to 4.3 mm (left Achille's tendon) and disappeared on right Achille's tendon. Pain also decreased from 9/10 to 4/10 on left Achille's tendon and from 5/10 to nothing on right tendon. Conclusions: Based on the authors` best knowledge, the current study was the first case report that confirmed the effectiveness of 5% acetic acid iontophoresis plus ultrasound to treat bilateral Achilles’ calcifying tendonitis.