What is the treatment for microtears in the Achilles tendon?

Treatment for Microtears in the Achilles Tendon

Initial treatment for Achilles tendon microtears should include relative rest, ice therapy, NSAIDs, heel lifts, open-backed shoes, and eccentric strengthening exercises for 6-8 weeks. 1

Diagnosis and Assessment

• Microtears in the Achilles tendon appear as focal fluid signals on MRI 2
• Diagnostic evaluation should include:
  • Physical examination: Look for pain at the tendon, thickening, and tender palpable nodules
  • Imaging: Ultrasound (92% accuracy for differentiating tear types) or MRI (95% sensitivity/specificity) 1

Conservative Treatment Protocol

Immediate Management (First 1-2 Weeks)

1. Relative Rest: Reduce activities that cause pain
2. Cryotherapy: Apply ice for 15-20 minutes several times daily
3. Pain Management: NSAIDs to reduce pain and inflammation
4. Biomechanical Support:
   • Heel lifts or orthoses to unload the tendon
   • Open-backed shoes to reduce pressure on the tendon 1

Progressive Rehabilitation (2-8 Weeks)

1. Eccentric Strengthening Exercises:

   • The most effective conservative treatment for Achilles tendinopathy 3, 1
   • Start with gentle eccentric loading and gradually increase intensity

2. Stretching:

   • Deep transverse friction massage of the gastrocnemius-soleus complex
   • Stretching exercises for posterior thigh muscles 3, 1

3. Gradual Return to Activity:

   • Based on functional improvement and pain reduction
   • Avoid sudden increases in training intensity or volume

Advanced Treatment Options

If conservative treatment fails after 6-8 weeks:

1. Biological Approaches:

   • Platelet-rich plasma (PRP) injections may promote rapid tendon healing in some cases 4
   • Note: The effectiveness of PRP may vary based on individual immune status 5

2. Surgical Consideration:

   • Surgical treatment should be considered for chronic tendinopathy unresponsive to 2-3 months of conservative care 1
   • Minimally invasive surgical techniques have shown promising results with fewer complications than open surgery 6

Important Considerations and Pitfalls

• Avoid corticosteroid injections directly into the tendon as they increase rupture risk 1
• Avoid prolonged immobilization which leads to muscle atrophy and deconditioning 1
• Address biomechanical factors such as foot pronation, pes planus, or heel varus that may contribute to the condition 3
• Consider bilateral assessment as tendon damage is often present bilaterally even when symptoms appear unilateral 1
• Weight loss may be indicated for overweight patients to reduce load on the tendon 1

Monitoring and Follow-up

• Regular clinical assessment of pain and function
• Progressive return to activities based on functional improvement
• Follow-up imaging may be useful to assess healing, but clinical improvement should guide treatment decisions

The American Academy of Family Physicians emphasizes that most Achilles tendon microtears can be successfully managed with conservative treatment, with surgical options reserved for cases that fail to respond after 2-3 months 1.