What is the treatment for left Achilles tendonitis?

Treatment for Left Achilles Tendonitis

Initial treatment for Achilles tendonitis should include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss if indicated. 1

First-Line Conservative Management

Immediate Interventions

• Activity modification: Reduce activities that aggravate symptoms
• Footwear changes:
  • Open-backed shoes to reduce pressure on the tendon
  • Heel lifts or orthoses to reduce tension on the Achilles tendon 1
• Pain management:
  • NSAIDs (such as naproxen 500mg twice daily) for pain and inflammation 1, 2
  • Ice application (cryotherapy) to reduce inflammation 1

Exercise Protocol

• Eccentric calf muscle training: The gold standard treatment for Achilles tendonitis 3
  • Perform heel drops on a step or raised surface
  • Start with 3 sets of 15 repetitions twice daily
  • Gradually increase load as tolerated
• Regular calf muscle stretching: Hold for 30 seconds, repeat 3-5 times daily 1

Important Cautions

• Avoid corticosteroid injections: Local injections of corticosteroids are not recommended for Achilles tendonitis due to increased risk of tendon rupture 1, 4
• NSAID use: Should be limited to the recommended dosage (for naproxen, initial total daily dose should not exceed 1250mg, thereafter not exceeding 1000mg daily) 2

Treatment Timeline and Progression

Weeks 0-6

Monitor for improvement with initial conservative measures. If symptoms improve within 6-8 weeks, continue treatments until symptoms resolve 1.

If No Improvement After 6 Weeks

Referral to a podiatric foot and ankle surgeon is appropriate. Initial treatments should be continued, and additional measures may include:

• Immobilization cast or fixed-ankle walker-type device 1
• Customized orthotic device
• Night splinting 1

If No Improvement After 2-3 Months

Consider more aggressive interventions:

• Cast immobilization if not previously used
• Possible surgical consultation 1
• Extracorporeal shock wave therapy may be considered 1

Special Considerations

For Athletes and Active Individuals

• More structured rehabilitation program with phased approach:
  • Initial phase (0-4 weeks): Pain control and protected range of motion
  • Intermediate phase (4-8 weeks): Progressive strengthening exercises
  • Advanced phase (8-12 weeks): Sport-specific training 5

Return to Activity Criteria

Return to full activity is permitted when:

• Complete resolution of pain during and after activity
• Full range of motion compared to uninjured side
• Strength symmetry >90% compared to uninjured side
• Successful completion of sport-specific functional tests 5

For Chronic Cases

Chronic Achilles tendinosis may require more prolonged treatment, with heavy load eccentric calf muscle training showing promising results for midportion Achilles tendinosis 6.

When to Consider Surgical Referral

• Persistent symptoms despite 3-6 months of well-managed conservative treatment
• Significant functional limitations impacting quality of life
• Evidence of progressive tendon degeneration on follow-up imaging 5

By following this structured approach to treating Achilles tendonitis, most patients will experience significant improvement in symptoms and function, avoiding the need for surgical intervention.