so I've done a fair amount of Achilles injections for tendinopathy it's something that's fairly common to have in athletics and one of the biggest issues that I personally have found is that you know how to do the best injection for these I personally at this point really like the short axis in plane and you can see in in plane you can see really nicely but unfortunately it's very very superficial so it could be harder to get in plane long axis injections so I do like the short axis finding your tendinopathy type of area and again this is not appropriate for cortisone but it is appropriate for doing biologics be a PRP stem cells whatever you're going to use and so at this point once you've localized your area again once again coming in in plane short axis coming straight in to the tendon we can get right into the tendon and then deliver whatever biologic we want to the tent itself if you want to localize and go superficial that's easy to do if you can go superficial on kind of the proximal aspect superficial aspect you can go deep as well and get under it so you can actually really surround it if you want you can see the fluid going in there you can see that I'm in the right spot because it's flowing up and down it's not creating a bubble so we know that it's not in a fat area it's definitely in the sheath itself and just flowing up and down so these are I think are the best ways to do these types of injections if you are going to do a cortisone which I'm not a fan of definitely going deep getting into the sheath making sure you're not in the tent itself is your most ideal spot if however you're going to do biologics you can in fact go into the tendon and do your injection into the tendon directly which is also appropriate and that's about it
