OBJECTIVE. The objective of our study was to report on changes in the short-term sonographic appearance and 2-year follow-up for pain outcomes in a large patient population with chronic Achilles tendinosis who underwent sonographically guided dextrose injections. SUBJECTS AND METHODS. One hundred eight tendons (86 midportion and 22 insertional) from 99 patients experiencing pain for greater than 6 months at either the Achilles tendon insertion or midportion were included in the study. Gray-scale (5-12 and 7-15 MHz) and color Doppler sonography examinations preceded the injection procedure using a 27-gauge needle administering a net 25% dextrose-lidocaine solution intratendinously. Structural features of each tendon and presence of neovascularity were noted. Visual analog scale (VAS) items were recorded at baseline, posttest, and 28.6 months follow-up. RESULTS. A median of five (range, 1-13) injection consultations were needed for each patient, spaced 5.6 ᠳ.1 (SD) weeks apart. There was a significant improvement in pain scores for both midportion (rest: 34.1 ᠲ7.7-3.3 ᠷ.4, activities of daily living (ADL): 50.2 ᠲ5.6-9.5 ᠱ6.2, and sport: 70.7 ᠲ3.3-16.7 ᠲ2.0) and insertional (rest: 33.0 ᠲ6.5-2.7 ᠶ.0, ADL: 51.3 ᠲ5.4-10.0 ᠱ6.3, and sport: 69.6 ᠲ4.5-17.7 ᠲ9.1) patients from baseline to follow-up for all VAS items. There were reductions in the size and severity of hypoechoic regions and intratendinous tears and improvements in neovascularity. CONCLUSION. Dextrose injections appear to present a low-cost and safe treatment alternative with good long-term evidence for reducing pain from pathology at either the insertion or midportion of the Achilles tendon.