From the Guidelines
Achilles tendinitis is best diagnosed and treated through a combination of physical examination, patient history, and sometimes imaging studies like ultrasound or MRI, with treatment typically beginning with conservative measures including rest, ice application, and eccentric strengthening exercises. The diagnosis of Achilles tendinitis involves a thorough physical examination, patient history, and imaging studies such as ultrasound or MRI to confirm the diagnosis and rule out other potential causes of heel pain 1.
Treatment Options
Treatment for Achilles tendinitis typically begins with conservative measures, including:
- Rest, ice application for 15-20 minutes several times daily, compression with an elastic bandage, and elevation of the affected foot
- Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (220-440mg twice daily) to help reduce pain and inflammation for 1-2 weeks
- Physical therapy focusing on eccentric strengthening exercises, like heel drops (3 sets of 15 repetitions twice daily for 12 weeks), which is highly effective for recovery 1
- Supportive footwear with adequate cushioning and possibly heel lifts (0.5-1cm) to reduce strain on the tendon
- Night splints to help maintain tendon flexibility during sleep
Advanced Treatments
For persistent cases, more advanced treatments may be considered, including:
- Extracorporeal shockwave therapy
- Platelet-rich plasma injections
- Rarely, surgical intervention
Recovery and Prevention
Recovery from Achilles tendinitis typically takes 3-6 months with proper treatment, and gradually returning to activities while avoiding sudden increases in intensity helps prevent recurrence 1. The condition results from repetitive stress causing microtears in the tendon, which is why addressing both inflammation and strengthening the tendon are crucial for successful treatment. Eccentric strength training is a particularly popular and effective option for treating Achilles tendinopathy, and anatomic misalignment can be treated with shoe orthotics to correct overpronation or pes planus problems 1.
From the Research
Diagnosis of Achilles Tendinitis
- Achilles tendinitis is typically diagnosed based on symptoms such as pain and stiffness in the Achilles tendon, as well as physical examination findings 2, 3, 4.
- Imaging studies such as ultrasound or MRI may be used to confirm the diagnosis and rule out other conditions 3, 4.
Treatment Options for Achilles Tendinitis
- Conservative treatment options for Achilles tendinitis include:
- Activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading 2, 3, 4.
- Shock wave therapy, which has been used to treat recalcitrant Achilles tendinopathy 2, 4.
- Eccentric training, which has been shown to be effective in reducing pain and improving function 4, 5.
- Surgical treatment may be recommended for patients who do not respond to conservative treatment, or for those with severe tendon damage 3, 4.
- Other treatment options that have been studied include:
- Graston Technique and Active Release Techniques, which are forms of soft tissue mobilization 5.
- Cryotherapy, which has been used in combination with other treatments to reduce pain and improve function 5.
- Low-level laser therapy, which has been studied as a potential treatment for Achilles tendinitis, but the evidence is limited 6.
Evidence for Treatment Effectiveness
- There is limited evidence to support the effectiveness of specific treatments for Achilles tendinitis, and more research is needed to determine the best course of treatment 2, 3, 4, 6.
- A systematic review of randomized controlled trials found that there was insufficient evidence to determine which method of treatment is the most appropriate for the treatment of acute or chronic Achilles tendinitis 6.
- However, some studies have reported positive outcomes with specific treatments, such as eccentric training and shock wave therapy 2, 4, 5.