From the Guidelines
Treatment for a large Achilles tendon calcification should initially focus on conservative management, including rest, ice application, and non-steroidal anti-inflammatory drugs (NSAIDs), with consideration of extracorporeal shock wave therapy (ESWT) for breaking down the calcification, as recommended by recent clinical guidelines 1. When managing Achilles tendon calcification, it's crucial to prioritize a stepwise approach, starting with the least invasive methods. Key components of conservative management include:
- Rest and avoidance of activities that aggravate the condition
- Ice application to reduce inflammation
- NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) for pain relief
- Physical therapy, focusing on gentle stretching and eccentric strengthening exercises to improve tendon health and reduce strain Considering the chronic nature of insertional Achilles tendonitis, as described in the context of heel pain management 1, a comprehensive treatment plan should also address potential biomechanical issues, such as improper footwear or gait abnormalities, which may contribute to the development and persistence of calcification.
For cases where conservative management does not yield sufficient improvement, more invasive procedures may be considered, such as:
- Corticosteroid injections around the tendon for pain relief, although this should be done with caution due to the risk of tendon weakening
- Ultrasound-guided needle lavage or percutaneous needling to break up the calcification
- Extracorporeal shock wave therapy (ESWT) as a non-invasive method to stimulate healing and break down calcification If these measures fail to provide relief after an extended period, typically 6-12 months, surgical intervention may be necessary to remove the calcification and repair the tendon, followed by a rehabilitation period. Throughout the treatment process, emphasizing proper footwear with adequate heel support and possibly heel lifts is essential to reduce tension on the tendon and support the healing process.
From the Research
Treatment Options for Achilles Tendon Big Calcification
- Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy 2
- Surgical treatment is recommended when nonsurgical treatment fails, with options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation 2
- The posterior midline approach can achieve satisfactory outcomes in the treatment of significantly calcified insertional Achilles tendinopathy, and gastrocnemius recession should be performed for patients with gastrocnemius contracture to improve the surgical outcome 3
- Debridement and repair of the Achilles tendon with reattachment of the Achilles tendon to the calcaneus, ostectomy of the calcaneus, and flexor hallucis longus tendon transfer can be an effective treatment for calcific insertional Achilles tendinopathy with concomitant posterior muscle group weakness 4
Non-Surgical Treatment
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat tendinopathy, but evidence for this treatment is lacking, and little is known regarding effects of NSAIDs on human tendinopathic tendon 5
- Short-term ibuprofen treatment has no effect on gene expression in human chronic tendinopathic tendon or leads to any clear changes in tendon pain or function 5
Surgical Techniques
- Calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer are additional or alternate procedures that may be used in the surgical treatment of insertional Achilles tendinopathy 2
- Recent advances in suture anchor techniques further add to the complexity of available options for the surgical treatment of insertional Achilles tendinopathy 2