From the Guidelines
Management of Achilles tendinitis should prioritize a combination of rest, activity modification, and eccentric strengthening exercises to promote collagen remodeling and reduce pain. The initial approach to managing Achilles tendinitis involves avoiding movements that aggravate symptoms and allowing relative rest of the affected area, as this prevents ongoing damage and reduces pain 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be used for short-term pain relief, but their long-term use is not recommended due to lack of evidence supporting their effectiveness in chronic tendinopathy 1.
Key Components of Management
- Eccentric strengthening exercises: Such as heel drops, which have been shown to promote collagen remodeling and are beneficial in Achilles tendinosus 1.
- Stretching exercises: Targeting the gastrocnemius and soleus muscles to improve flexibility.
- Orthotic devices: Like heel lifts, which can reduce tendon strain.
- Night splints: To maintain ankle dorsiflexion during sleep and prevent morning stiffness.
- Addressing biomechanical factors: Such as improper footwear or training errors, is essential for preventing recurrence.
Additional Considerations
- Ice application can provide short-term pain relief by reducing inflammation and tissue metabolism 1.
- Corticosteroid injections are generally avoided due to the increased risk of tendon rupture.
- For cases unresponsive to conservative treatment, options like extracorporeal shock wave therapy or surgical interventions, including tendon debridement or repair, may be considered after 3-6 months of conservative management 1.
From the Research
Management Options for Achilles Tendinitis
The management of Achilles tendinitis involves a range of options, including conservative and surgical treatments.
- Conservative treatment usually relieves symptoms, but treatment may be prolonged 2.
- Causative factors such as improper training or biomechanical abnormalities must be corrected to prevent reoccurrence 2, 3.
- The treatment should be based on individual patient considerations and expectations 2.
Conservative Treatment
Conservative treatment options include:
- Rest, ice, anti-inflammatory measures, and physical rehabilitation 2, 3.
- Platelet-rich plasma (PRP) injections, which have been shown to produce good overall results for the treatment of chronic recalcitrant Achilles tendinopathy 4, 5.
- Rehabilitation of the gastrocnemius/soleus muscle-tendon unit, control of inflammation and pain, and control of biomechanical parameters 3.
Surgical Treatment
Surgical treatment may occasionally be recommended, especially in cases of Achilles tendon rupture 2.
- However, there is some controversy regarding the advantage of conservative versus surgical management 2.
- The decision to undergo surgical treatment should be based on individual patient considerations and expectations 2.
Etiological Factors
The etiological factors of Achilles tendinitis include: