What is the treatment for Achilles tendonitis?

From the Guidelines

Treatment for Achilles tendonitis should primarily involve eccentric strength training, as it is a particularly popular and effective option, along with stretching and deep friction massage of the gastrocnemius-soleus complex, as recommended by the American Family Physician in 2005 1. The goal of treatment is to reduce pain and inflammation, promote healing, and improve function. Initially, reducing activities that cause pain and following the RICE protocol (rest, ice, compression, and elevation) can help alleviate symptoms.

• Rest the affected area to avoid further strain on the tendon
• Apply ice for 15-20 minutes several times daily to reduce inflammation
• Compress with an elastic bandage to provide support
• Elevate the foot when possible to reduce swelling Over-the-counter NSAIDs like ibuprofen or naproxen can help manage pain and inflammation for a short period, typically 1-2 weeks.
• Ibuprofen: 400-800mg three times daily with food
• Naproxen: 220-440mg twice daily Physical therapy focusing on eccentric strengthening exercises is crucial for recovery.
• Heel drops: standing on a step, rising onto tiptoes, then slowly lowering the heel below step level for 3 sets of 15 repetitions twice daily
• Stretching the calf muscles: leaning against a wall with the affected leg extended behind you for 30 seconds, repeated 3-5 times daily Supportive footwear with proper arch support and heel cushioning is important, and temporary heel lifts may reduce tension on the tendon. Most cases improve within 6-8 weeks with consistent treatment, though severe cases might require longer recovery or additional interventions like corticosteroid injections or, rarely, surgery, as noted in the American Family Physician in 2005 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 treatment for Achilles tendonitis includes the use of naproxen. The recommended starting dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.

• The initial total daily dose should not exceed 1250 mg of naproxen.
• Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.

From the Research

Treatment Options for Achilles Tendonitis

• Conservative management options for chronic Achilles tendinopathy include:
  • Eccentric (lengthening) exercises 3
  • Extracorporeal shockwave therapy (ESWT) 3, 4
  • Topical nitroglycerin 3
  • Low level laser therapy 3
  • Orthoses, splints or injections (e.g. corticosteroids, hyperosmolar dextrose, polidocanol, platelet-rich plasma) 3, 5, 6, 7
• Surgical treatment may be recommended for a minority of patients 3, 5
• Treatment for acute injuries usually involves rest, ice, anti-inflammatory measures, and physical rehabilitation 5

Specific Treatments

• Platelet-rich plasma (PRP) treatment has been shown to be effective in treating chronic Achilles tendinosis, with significant improvements in symptoms and function 6, 7
• Extracorporeal shock wave therapy (ESWT) has been used to treat Achilles tendinopathy, but conclusive evidence recommending it as a treatment is lacking 4

Treatment Goals

• The goal of treatment is to relieve symptoms, promote healing, and prevent reoccurrence 5
• Treatment should be based on individual patient considerations and expectations 5