From the Guidelines
Treatment for Achilles tendinitis should prioritize a combination of rest, physical therapy, and pain management, with a focus on eccentric strengthening exercises and proper footwear support, as this approach has been shown to improve symptoms in most cases within 3-6 months. Initially, reducing activities that cause pain and following the RICE protocol (rest, ice, compression, and elevation) can help alleviate symptoms. Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) can be used for short-term pain management, as recommended by 1.
Key Components of Treatment
- Eccentric strengthening exercises, such as heel drops, are crucial for recovery, as they help rebuild tendon strength while reducing inflammation, as noted in 1.
- Stretching the calf muscles several times daily maintains flexibility and supports the healing process.
- Proper footwear with adequate support, possibly including heel lifts or orthotics, can reduce strain on the tendon, as discussed in 1 and 1.
- Most cases improve within 3-6 months with conservative treatment, but if symptoms persist beyond 6 months, additional interventions like extracorporeal shockwave therapy, platelet-rich plasma injections, or rarely, surgery might be considered, as suggested by 1.
Approach to Treatment
The approach to treating Achilles tendinitis should be conservative, focusing on addressing the underlying causes of the condition, such as improper technique, anatomic misalignment, or uneven training surfaces, as mentioned in 1. By prioritizing rest, physical therapy, and pain management, and incorporating eccentric strengthening exercises and proper footwear support, patients can effectively manage their symptoms and promote recovery, as supported by the recommendations in 1 and 1.
From the Research
Treatment Options for Achilles Tendinitis
The treatment for Achilles tendinitis can be divided into conservative and surgical management.
- Conservative treatment includes:
- Activity modification
- Heel lifts
- Arch supports
- Stretching exercises
- Nonsteroidal anti-inflammatories
- Eccentric loading 2
- Rest, ice, anti-inflammatory measures, and physical rehabilitation for acute injuries such as insertional tendonitis, retrocalcaneal bursitis, and paratenonitis 3
- Tendon loading exercises and symptom modulating treatments such as topical, oral, or injected medication, ice, shoe inserts, manual therapy, stretching, taping, or low-level laser for midsubstance Achilles tendinopathy 4
- Surgical treatment may be recommended when conservative treatment fails, and can include options such as:
Non-Invasive Treatment Measures
When conservative therapy fails, other non-invasive treatment measures may be considered, such as:
- Extracorporeal shock wave therapy (ESWT) for recalcitrant Achilles tendinopathy 2
- Shockwave or sclerosing treatment for midsubstance Achilles tendinopathy 4
Treatment Approach
The treatment approach should be based on individual patient considerations and expectations 3, and may involve a combination of conservative and surgical management options. There is currently no consensus on the best treatment for Achilles tendinosis, and treatment options range from conservative to surgical 6.