What is the recommended treatment for Achilles tendonitis?

From the Guidelines

The recommended treatment for Achilles tendonitis is a combination of rest, ice, anti-inflammatory medications, and physical therapy, with a focus on eccentric strengthening exercises of the calf muscles, as this approach has been shown to be effective in reducing pain and promoting healing 1.

Key Components of Treatment

• Rest and avoidance of high-impact activities to reduce strain on the tendon
• Ice application to the affected area for 15-20 minutes several times daily
• Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) for short-term use (7-14 days)
• Physical therapy focusing on gentle stretching and eccentric strengthening exercises of the calf muscles
• Supportive footwear with adequate cushioning and possibly heel lifts (0.5-1cm) to reduce strain on the tendon
• Night splints to maintain ankle flexibility while sleeping

Treatment Outcomes

Most cases of Achilles tendonitis improve within 6-8 weeks with conservative treatment 1. If pain persists beyond 2-3 months despite these measures, medical evaluation is recommended to consider more advanced interventions like corticosteroid injections, platelet-rich plasma therapy, or in rare cases, surgery 1.

Important Considerations

• Accurate diagnosis is crucial to develop an effective treatment plan, and physicians should recognize the historical features, anatomy, and useful physical examination maneuvers for Achilles tendonitis 1.
• Treatment should be conservative, and surgery should be reserved for patients who have failed conservative therapy 1.
• Eccentric strength training is a particularly popular and effective option for treating Achilles tendonitis, and stretching and deep friction massage of the gastrocnemius-soleus complex can also be helpful 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 Achilles tendonitis is naproxen with a starting dose of 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.

From the Research

Treatment Options for Achilles Tendonitis

• Conservative treatment is often the first line of treatment for Achilles tendonitis, with options including rest, ice, anti-inflammatory measures, and physical rehabilitation 3.
• Eccentric exercise training is considered the gold standard for treating Achilles tendonitis, and is a commonly used protocol 4.
• Activity modification and rehabilitation, with a focus on progressive tendon-loading, can also be effective in treating Achilles tendonitis 5.
• For recalcitrant cases, adjuvant treatment with procedures such as injections or shockwave therapy may be necessary, and rarely, surgical intervention may be required 5.

Emerging Techniques in Treatment

• Newer conservative techniques, such as platelet-rich plasma (PRP) injections, are being investigated for the treatment of Achilles tendonitis 6, 7.
• Post-PRP protocols can vary, but may include restrictions on movement and weight bearing, use of orthoses, activity modifications, and rehabilitation protocols 7.
• The majority of protocols instituted after PRP injection include a period of stretching and strengthening, with stretching programs generally beginning 2-7 days following injection, and strengthening programs beginning within 2-3 weeks 7.

Considerations for Treatment

• Treatment should be based on individual patient considerations and expectations 3.
• Causative factors, such as improper training or biomechanical abnormalities, must be corrected to prevent reoccurrence of Achilles tendonitis 3.
• Imaging modalities may be helpful in the diagnosis of difficult cases or in the planning of interventional procedures 5.