What is the treatment for bilateral Achilles tendonitis with a fusiform disorder, causing pain with running and jumping?

From the Guidelines

Treatment for bilateral Achilles tendonitis with fusiform disorder should prioritize eccentric strength training, as it is a particularly popular and effective option, along with stretching and deep friction massage of the gastrocnemius-soleus complex. The condition, characterized by pain with running and jumping, is common among adult runners and is often associated with anatomic deformities such as forefoot and heel varus and excessive pes planus or foot pronation 1.

Key Components of Treatment

• Eccentric strength training to promote healing of the collagen fibers
• Stretching of the gastrocnemius and soleus muscles to improve flexibility
• Deep friction massage to reduce tendon thickening and promote healing
• Use of shoe orthotics to correct overpronation or pes planus problems, and heel lift orthotics to unload the tendon for pain relief, as suggested by the study on common overuse tendon problems 1

Additional Considerations

• Activity modification and relative rest to reduce symptoms
• Ice application and non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation management
• Supportive footwear with adequate cushioning and possibly heel lifts to reduce tension on the Achilles tendon
• Night splints to maintain tendon flexibility during sleep
• Consideration of extracorporeal shock wave therapy or platelet-rich plasma injections for persistent cases, although the study by 1 emphasizes the importance of conservative treatment approaches. Given the multifactorial etiology and pathogenesis of Achilles tendinopathy, a comprehensive treatment plan addressing these factors is crucial for effective management and reduction of morbidity, mortality, and improvement of quality of life.

From the Research

Treatment Options for Bilateral Achilles Tendonitis with Fusiform Disorder

• The treatment for bilateral Achilles tendonitis with a fusiform disorder, causing pain with running and jumping, can include various conservative approaches 2.
• Eccentric exercise and shock wave therapies have been shown to be effective treatments with high evidence-based effectiveness 2.
• Other conservative treatments that have been researched include nonsteroidal anti-inflammatory medication, stretching, orthotics, bracing, glyceryl trinitrate patches, injection therapies (corticosteroids, hyaluronic acid, platelet-rich plasma injections), and low-level laser therapy 2.
• Platelet-rich plasma (PRP) injections have been studied as a treatment option for Achilles tendinopathy, but the evidence is mixed, with some studies suggesting an advantage of using PRP, while higher-level evidence studies do not support significant efficacy 3, 4.

Diagnosis and Rehabilitation

• Achilles tendinopathy is a clinical diagnosis, and imaging modalities may be helpful in difficult cases or in planning interventional procedures 5.
• Midportion (noninsertional) and insertional tendinopathy have distinct features and differences for therapeutic paradigms 5.
• Overall, Achilles tendinopathy has a good clinical prognosis with most patients improving with activity modification and rehabilitation, with a focus on progressive tendon-loading 5.
• An accurate diagnosis and early conservative management can improve patient quality of life and reduce unnecessary surgical consultations 6.

Specific Considerations for Fusiform Disorder

• Fusiform disorder is a type of Achilles tendonitis that can cause pain and swelling in the affected area.
• The treatment approach for fusiform disorder may involve a combination of conservative therapies, such as eccentric exercise, shock wave therapy, and injection therapies 2.
• It is essential to work with a healthcare professional to develop a personalized treatment plan that addresses the specific needs and goals of the patient 6.