What is the treatment for Achilles tendinitis?

From the Guidelines

Treatment for Achilles tendinitis should prioritize a combination of rest, physical therapy, and pain management to minimize morbidity, mortality, and improve quality of life. The most effective approach includes reducing activities that cause pain and following the RICE protocol: rest the affected area, apply ice for 15-20 minutes several times daily, compress with an elastic bandage, and elevate the foot when possible 1. Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) can help manage pain and inflammation for short periods, as they are recommended for short-term pain relief but have no effect on long-term outcomes 1.

Key Components of Treatment

• Eccentric strengthening exercises are an effective treatment for tendinopathy and may reverse degenerative changes, with examples including heel drops performed by standing on a step, rising onto tiptoes, then slowly lowering the heel below step level for 3 sets of 15 repetitions twice daily 1.
• Stretching exercises for the calf muscles should be done gently, holding each stretch for 30 seconds, 3-5 times daily.
• Night splints may help maintain tendon flexibility during sleep.
• Proper footwear with adequate support and possibly heel lifts can reduce strain on the tendon.

Additional Considerations

• Cryotherapy provides acute relief of tendinopathy pain, with repeated applications of melting ice water through a wet towel for 10-minute periods being most effective 1.
• Topical NSAIDs are effective and may have fewer systemic side effects, although it is unclear whether they are better than other analgesics 1.
• Locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes 1.
• Extracorporeal shock wave therapy appears to be a safe, noninvasive, effective but expensive means of pain relief for chronic tendinopathies 1.
• Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1.

Recovery and Prevention

Recovery requires patience as rushing back to full activity can lead to reinjury. Most cases improve within 3-6 months with conservative treatment. If symptoms persist beyond 6 months, additional interventions like extracorporeal shockwave therapy or, in severe cases, surgery might be considered 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 tendinitis may include 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, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.

From the Research

Treatment Options for Achilles Tendinitis

• Standard treatment regimens include activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading 3
• Conservative management may prove to be inadequate for a subset of patients, and other noninvasive treatment measures such as extracorporeal shock wave therapy (ESWT) may be considered 3
• Nonsurgical treatment often includes a combination of rest, NSAIDs, correction of malalignments, and stretching and strengthening exercises, but there is sparse scientific evidence supporting the use of most proposed treatment regimens 4
• Heavy load eccentric calf muscle training has shown promising results and may possibly reduce the need for surgical treatment of tendinosis located in the midportion of the Achilles tendon 4

Surgical Treatment

• Surgical treatment is required in about 25% of patients with chronic Achilles tendinosis 4
• The short-term results after surgical treatment are frequently very good, but there are signs of a possible deterioration with time 4
• Calf muscle strength takes a long time to recover after surgical treatment, and a prolonged progressive calcaneal bone loss has been shown on the operated side up to 1 year after surgical treatment 4
• Long-term results of surgical management of Achilles tendinitis in runners have shown successful outcomes, but symptoms may recur in some cases 5

Orthotic Devices and Other Interventions

• Orthotic devices such as foot orthoses, splints, taping, and bracing are recommended for Achilles tendinopathy, but the evidence for their effectiveness is weak or very weak 6
• Foot orthoses have been shown to be equivalent to physical therapy or no treatment, while adhesive taping alone or combined with foot orthoses has very weak evidence supporting its use 6
• The AirHeel™ brace has been shown to be as effective as a calf muscle eccentric exercise programme, but adding it to such a programme may not be beneficial 6
• Ankle joint dorsiflexion night splint has been shown to be equally effective to a calf muscle eccentric exercise programme, but adding it to such a programme may not be beneficial 6
• Corticosteroid injections have shown weak evidence suggesting a short-term improvement in pain and reduction in abnormal ultrasound detectable features, but the overall validity of the studies is low 7