The ASPIRE Trial: AchilleS tendinoPathy Treated With cortIcosteRoid injEctions

Inclusion Criteria: * Age 18-65 years * Clinically diagnosed midportion Achilles tendinopathy confirmed by ultrasound * Symptoms for at least 6 months * Persistent complaints despite standard care, including education, load management advice and at least 3 months of exercise therapy / exercise programme Exclusion Criteria: * • Clinical suspicion of insertional Achilles tendinopathy * Clinical suspicion of Achilles tendon rupture * Clinical suspicion of plantar flexor tenosynovitis * Clinical suspicion of sural nerve pathology * Clinical suspicion of peroneal tendon subluxation or peroneal tendinopathy * Clinical suspicion of posterior ankle impingement syndrome * Suspected systemic/inflammatory disorder as cause of symptoms * Any condition preventing participation in active exercise programme * History of Achilles tendon rupture of index tendon * Previous local corticosteroid injection on index Achilles tendon * Previous surgery on index Achilles tendon * Refusal to undergo one of the study treatments * Local skin infection, suspected systemic infection with fever, or other medical condition compromising injection safety * Vitamin K antagonist use with INR \>3.0 within 3 days before injection or unknown INR * Current pregnancy or breastfeeding * Medication-induced tendon pathology (quinolones or statins related to symptom onset) * Inability to provide informed consent * Participation in another concomitant interventional programme for Achilles tendinopathy * Known hypersensitivity or allergy to Depo-Medrol or Lidocaine * Participants with unstable or poorly controlled diabetes mellitus may be excluded at investigator discretion for safety reasons.