From the Guidelines
Achilles bursitis should be treated with initial options including open-backed shoes, orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated), as these measures can help reduce pressure on the area and alleviate symptoms. According to 1, these initial treatment options may be sufficient to manage the condition, and if improvement occurs within six to eight weeks, treatments can be continued until symptoms resolve. It is essential to note that local injections of corticosteroids are not recommended, as stated in 1.
Key Considerations
- Wearing proper footwear with adequate heel cushioning is crucial to reduce pressure on the affected area
- Avoiding activities that aggravate symptoms is essential to prevent further irritation
- NSAIDs, such as ibuprofen or naproxen, can be used to reduce pain and inflammation
- Stretching exercises and physical therapy may be beneficial in severe cases
- Surgery is rarely needed but may be considered for persistent cases, as mentioned in 1 and 1
Additional Treatment Options
- Immobilization may be considered in particularly acute or refractory cases, as stated in 1
- Referral to a podiatric foot and ankle surgeon may be necessary if no improvement occurs after six weeks, as recommended in 1 and 1
- Further options, such as customized orthotic devices, night splinting, or extracorporeal shock wave therapy, may be explored if initial treatments are unsuccessful, as mentioned in 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. CLINICAL STUDIES ... Naproxen has been studied in patients with ... tendonitis and bursitis, and acute gout
Achilles Bursitis Treatment with Naproxen:
- The recommended starting dose of naproxen for acute tendonitis and bursitis is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
- Naproxen may be used for the management of acute painful conditions such as Achilles bursitis when prompt onset of pain relief is desired 2.
- Naproxen has been studied in patients with tendonitis and bursitis, demonstrating its effectiveness in these conditions 2.
From the Research
Achilles Bursitis Treatment
- The treatment of Achilles bursitis can involve various methods, including corticosteroid injections and nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5.
- A study published in 2016 found that ultrasound-guided corticosteroid injection was effective in reducing pain and inflammation in patients with Achilles tendinitis and bursitis 3.
- Another study published in 2017 found that short-term ibuprofen treatment had no effect on gene expression in human chronic tendinopathic tendon, suggesting that tendinopathic cells may not be responsive to NSAIDs 4.
- A comparison of nimesulide and naproxen sodium in the treatment of tendinitis and bursitis found similar efficacy and tolerability between the two groups, with the main side effects being gastrointestinal 5.
Comparative Effectiveness of Treatments
- A living systematic review with network meta-analysis of 29 randomized controlled trials found that any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months, but there was large uncertainty in the comparative estimates 6.
- The review found that exercise therapy, exercise+injection therapy, and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy at 12 months, but the certainty of evidence was very low to low 6.
- The authors suggested that exercise therapy could be considered as a starting treatment due to its ease of prescription, low cost, and few harms 6.