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. According to the study by 1, conservative treatment is recommended, and eccentric strength training is highlighted as a key component. This approach is supported by the fact that Achilles tendinopathy is often associated with anatomic deformities such as forefoot and heel varus and excessive pes planus or foot pronation, which can be addressed through shoe orthotics to correct overpronation or pes planus problems.
Some key considerations for treatment include:
- Identifying and addressing anatomic misalignment through the use of shoe orthotics
- Using heel lift orthotics to unload the tendon for pain relief
- Implementing a regimen of stretching and deep friction massage to alleviate symptoms
- Focusing on eccentric strength training as a primary method of treatment, as evidenced by 1
It's also important to note that the etiology and pathogenesis of Achilles tendinosus tend to be multifactorial, including improper technique, anatomic misalignment, weakness, uneven training surfaces, and improperly fitted footwear, as discussed in the study by 1. By addressing these factors and incorporating eccentric strength training and other conservative measures, patients can effectively manage their symptoms and promote recovery.
From the Research
Treatment Options for Achilles Tendonitis
The treatment for Achilles tendonitis can vary, and several options are available. Some of these options include:
- Platelet-rich plasma (PRP) injections: Studies such as 2, 3, and 4 have investigated the use of PRP injections for treating Achilles tendonitis, with some showing improvement in functional outcome measures and reduction in pain.
- Eccentric exercise: This is a common treatment approach for Achilles tendonitis, although the provided studies do not directly compare its effectiveness to PRP injections.
- Placebo injections: Some studies, such as 4 and 5, have used placebo injections as a control group to compare the effectiveness of PRP injections.
- Non-steroidal anti-inflammatory drugs (NSAIDs): The study 6 mentions the use of NSAIDs for alleviating acute symptoms of Achilles tendinitis, but notes that the evidence is weak.
Effectiveness of Platelet-Rich Plasma Injections
The effectiveness of PRP injections for treating Achilles tendonitis is still being researched, and the results are mixed. Some studies, such as 3 and 4, have found PRP injections to be effective in reducing pain and improving function, while others, such as 2 and 5, have found no significant difference between PRP injections and control groups. The study 4 found that PRP injections exhibited better efficacy than placebo treatment at 6 weeks after treatment, but there was no significant difference at 12 weeks, 24 weeks, and 1 year after treatment.
Comparison of Treatment Outcomes
The studies provided compare the outcomes of different treatment approaches for Achilles tendonitis, including PRP injections, eccentric exercise, and placebo injections. The results of these comparisons are:
- PRP injections vs. placebo injections: The study 4 found that PRP injections were more effective than placebo injections at 6 weeks after treatment, but there was no significant difference at later time points.
- PRP injections vs. eccentric exercise: The study 4 compared the effectiveness of PRP injections to eccentric exercise, but the results are not directly comparable to the other studies provided.
- PRP injections vs. NSAIDs: The study 6 mentions the use of NSAIDs for alleviating acute symptoms of Achilles tendinitis, but does not directly compare their effectiveness to PRP injections.