From the Guidelines
Treatment for pes cavus associated tendonitis should begin with conservative measures, including rest, ice, and anti-inflammatory medications, as well as custom orthotic inserts and physical therapy to address the biomechanical abnormalities of pes cavus. The goal of treatment is to reduce pain and inflammation, improve function, and prevent further injury. According to 1, most patients with overuse tendinopathies fully recover within three to six months with conservative treatment.
Conservative Measures
- Rest and ice to reduce inflammation and pain
- Anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 7-14 days
- Custom orthotic inserts with arch support and cushioning to redistribute pressure and accommodate the high arch structure
- Physical therapy focusing on stretching tight structures (particularly the Achilles tendon and plantar fascia) and strengthening weak muscles around the ankle and foot, performed 2-3 times weekly for 6-8 weeks
- Proper footwear with adequate cushioning and support, including a wide toe box and good shock absorption
Additional Treatments
- Night splints to maintain tendon flexibility during sleep
- Corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) for temporary relief, limited to 2-3 injections per year
- Eccentric strength training, stretching, and deep friction massage of the gastrocnemius-soleus complex, as recommended by 1
Surgical Options
If conservative measures fail after 3-6 months, surgical options including tendon repairs or osteotomies to correct foot alignment may be considered, as suggested by 1 and 1. However, surgery should be reserved for patients who have failed conservative therapy.
It is essential to note that the treatment of pes cavus associated tendonitis should prioritize the reduction of pain and inflammation, improvement of function, and prevention of further injury, with a focus on conservative measures and a cautious approach to surgical options, as supported by 1, 1, and 1.
From the FDA Drug Label
Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
The recommended treatment for acute tendonitis is naproxen 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2.
- The initial total daily dose should not exceed 1250 mg of naproxen.
- Thereafter, the total daily dose should not exceed 1000 mg of naproxen. However, pes cavus associated tendonitis is not explicitly mentioned in the provided drug labels. Therefore, no conclusion can be drawn for this specific condition.
From the Research
Treatment Options for Pes Cavus Associated Tendonitis
- The treatment of pes cavus associated tendonitis is often multifaceted and may involve a combination of conservative management options 3, 4.
- Customized foot orthoses have been shown to improve pain and function in patients with pes cavus, with a significant reduction in foot pain and improvement in foot function compared to sham orthoses 5, 6.
- The use of orthotic intervention may be effective in improving pain and function in painful, idiopathic pes cavus, although the mechanisms by which this occurs are unclear 5.
- There is limited evidence to support the use of other interventions, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, corticosteroid injections, casts, physical therapy, ice, and heat, for the treatment of pes cavus associated tendonitis 3.
Recommended Treatment Approach
- A combination of conservative management options, including customized foot orthoses, may be recommended for the treatment of pes cavus associated tendonitis 6.
- The treatment approach should be individualized and based on a thorough evaluation of the patient's symptoms and foot deformity 7, 4.
- Further research is needed to fully understand the efficacy of different treatment options for pes cavus associated tendonitis and to develop evidence-based guidelines for management 3, 6.