What is the recommended treatment for ankle tendinitis?

Treatment for Ankle Tendinitis

The recommended treatment for ankle tendinitis includes NSAIDs for pain relief, exercise therapy focused on eccentric strengthening, and functional support with a brace for 4-6 weeks, while avoiding immobilization and corticosteroid injections near the affected area. 1, 2, 3

Initial Management

• Activity Modification:

  • Implement relative rest without complete immobilization
  • Reduce activities that cause pain
  • Avoid flat shoes and barefoot walking 4

• Pain Management:

  • NSAIDs are recommended for short-term pain relief 1, 5
    • Naproxen 500mg twice daily (recommended dose for acute tendinitis) 5
    • Ibuprofen 1.2-2.4g daily, can be combined with paracetamol for enhanced pain relief 4
  • Cryotherapy for acute pain relief 4

• Functional Support:

  • Use of a brace is preferred over immobilization for 4-6 weeks 1
  • Avoid prolonged immobilization (>4 weeks) as it leads to muscle atrophy and worse outcomes 4

Rehabilitation Program

Early Phase (0-2 weeks)

• Focus on pain control and protected range of motion
• Begin gentle ankle exercises as pain allows
• Use of open-backed shoes or heel lifts may help reduce tendon strain 4

Intermediate Phase (2-6 weeks)

• Progressive strengthening exercises
• Eccentric strengthening exercises - highest evidence-based effectiveness for tendinopathy 4, 2, 3
• Proprioceptive training

Advanced Phase (6-12 weeks)

• Sport or activity-specific training
• Gradual return to full activity when patient demonstrates:
  • Complete resolution of pain
  • Full range of motion
  • Strength symmetry >90% compared to uninjured side 4

Treatment Considerations for Specific Ankle Tendons

Posterior Tibial Tendinopathy

• May require orthotic support to correct flat-foot deformity
• More aggressive immobilization may be needed in severe cases 2

Peroneal Tendinopathy

• Often misdiagnosed as lateral ankle sprain
• Focus on lateral ankle strengthening and proprioception 2

Achilles Tendinopathy

• Eccentric calf muscle strengthening has strongest evidence base
• Pain typically located 4-6cm above calcaneal insertion 2, 6

Anterior Tibial Tendinopathy

• More common in patients over 45 years
• May require short-term immobilization before starting physical therapy 2

When to Consider Additional Interventions

• If no improvement after 6-8 weeks of conservative treatment:

  • Consider referral to specialist 4
  • Extracorporeal shock wave therapy may be considered after 3-6 months of failed conservative management 4

• Surgical intervention should only be considered when:

  • Conservative measures fail after 3-6 months of well-managed treatment
  • Significant functional limitation persists 4, 6

Important Cautions

• Avoid corticosteroid injections near the affected tendon as they may increase risk of tendon rupture 4, 3
• Avoid prolonged use of NSAIDs as they may interfere with the natural healing process 1
• Inadequate rehabilitation increases risk of chronic problems and recurrence 4, 2
• Recognize that tendinopathy is now understood as a degenerative process rather than an inflammatory one, which affects treatment approach 2, 3