What is the treatment for Achilles tendonitis?

From the Guidelines

Treatment for Achilles tendonitis should prioritize a combination of rest, physical therapy, and medication, with a focus on eccentric strengthening exercises and avoiding corticosteroid injections, as recommended by the most recent and highest quality study 1. The initial approach to managing Achilles tendonitis involves reducing activities that exacerbate pain and following the RICE protocol: rest, ice, compression, and elevation.

• Rest the affected area to prevent 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 reduce 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 exercises are crucial for recovery, including:
• Gentle stretching of the Achilles tendon and calf muscles
• Gradually progressing to strengthening exercises, with a focus on eccentric heel drops Eccentric heel drops are particularly effective: stand on a step with heels hanging off, rise onto tiptoes, then slowly lower heels below step level, repeating 15 times for 3 sets daily. Proper footwear with adequate support and cushioning is essential, and temporary heel lifts may reduce tendon strain. Most cases improve within 6-12 weeks with consistent treatment, as noted in 1. If pain persists beyond 3 months or worsens despite these measures, medical evaluation is necessary to consider more intensive treatments like extracorporeal shockwave therapy or, in rare cases, surgery, as discussed in 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 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. Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.

From the Research

Treatment Options for Achilles Tendonitis

• The treatment for Achilles tendonitis can vary, with some studies suggesting the use of corticosteroid injections to reduce pain and inflammation 3, 4.
• However, the evidence for the effectiveness of corticosteroid injections is weak, and there are concerns about potential side effects, such as tendon rupture 4.
• Other treatment options include non-pharmacological interventions, such as physical therapy and eccentric loading, although there is limited research on their effectiveness for Achilles tendonitis in patients with inflammatory arthritis 3.
• Shock wave therapy has also been explored as a potential treatment for Achilles tendinopathy, but conclusive evidence is lacking 5.
• Injectable celecoxib nanoparticle hydrogels have shown promise in reducing inflammation and promoting tissue regeneration in the treatment of chronic Achilles tendonitis 6.
• Treatment for Achilles tendinosis, a degenerative process of the tendon, is based on whether to stimulate or prevent neovascularization, with various options ranging from conservative to surgical approaches 7.

Non-Pharmacological Interventions

• Non-pharmacological interventions, such as physical therapy and eccentric loading, are commonly used to treat Achilles tendonitis, but there is limited research on their effectiveness for patients with inflammatory arthritis 3.
• Shock wave therapy has been used to treat Achilles tendinopathy, but more research is needed to determine its effectiveness 5.

Pharmacological Interventions

• Corticosteroid injections have been used to reduce pain and inflammation in Achilles tendonitis, but the evidence for their effectiveness is weak, and there are concerns about potential side effects 3, 4.
• Injectable celecoxib nanoparticle hydrogels have shown promise in reducing inflammation and promoting tissue regeneration in the treatment of chronic Achilles tendonitis 6.