What is the treatment for Achilles tendinitis?

Treatment of Achilles Tendinitis

Eccentric strengthening exercises are the gold standard and most effective conservative treatment for Achilles tendinopathy, combined with activity modification, stretching, and NSAIDs for pain relief. 1

Initial Treatment Approach

First-Line Interventions (0-6 weeks)

• Reduce activities that cause pain while continuing activities that don't worsen symptoms to prevent ongoing damage 1
• Implement regular calf-muscle stretching exercises to improve flexibility and reduce tension on the tendon 2, 1
• Perform eccentric strengthening exercises to stimulate collagen production and guide normal alignment of newly formed fibers 1
• Apply ice (cryotherapy) for short-term pain relief to reduce tissue metabolism and blunt inflammatory response 2, 1
• Use over-the-counter heel cushions and arch supports to unload the tendon 2
• Consider weight loss if indicated 2
• Avoid flat shoes and barefoot walking 2
• Use open-backed shoes to reduce pressure on the affected area 2, 1
• Take NSAIDs for pain relief (oral or topical), with topical having fewer systemic side effects 2, 1, 3

Important Considerations

• Avoid corticosteroid injections into or around the Achilles tendon as they may inhibit healing, reduce tensile strength, and predispose to spontaneous rupture 1
• For insertional Achilles tendinitis, local injections of corticosteroids are specifically not recommended 2
• NSAIDs like naproxen can provide pain relief within 1 hour, with recommended dosing of 500 mg initially followed by 250 mg every 6-8 hours as needed (not exceeding 1250 mg on first day and 1000 mg daily thereafter) 3

Secondary Interventions (if no improvement after 6-8 weeks)

Referral to Specialist

• If no improvement occurs after 6-8 weeks, referral to a podiatric foot and ankle surgeon is appropriate 2, 1
• Continue initial treatment measures while adding additional interventions 2

Additional Treatment Options

• Customized orthotic devices to correct biomechanical issues 2
• Night splinting to maintain tendon length 2
• Immobilization with cast or fixed-ankle walker-type device for particularly acute or refractory cases 2
• Physical therapy interventions (land-based preferred over aquatic) 2

Special Considerations

Biomechanical Factors

• Pay special attention to anatomic deformities such as forefoot and heel varus, excessive pes planus, or foot pronation, as these biomechanical factors often contribute to the development and persistence of Achilles tendinopathy 1, 4

For Bursitis Associated with Haglund's Deformity

• Use open-backed shoes, orthoses, and accommodative padding 2
• Consider corticosteroid injections (avoiding the Achilles tendon itself) 2
• Weight loss if indicated 2
• Physical therapy 2

Advanced Treatment Options (for refractory cases)

• If conservative treatment fails after 2-3 months, consider:
  • Cast immobilization if not previously used 2
  • Extracorporeal shock wave therapy for recalcitrant cases 2, 5
  • Surgical intervention (plantar fasciotomy) as a last resort 2, 6

Monitoring and Follow-up

• Continue treatments until symptoms resolve if improvement occurs 2
• Regularly assess pain levels, range of motion, and functional capacity 1
• Gradually return to activity as symptoms improve, avoiding sudden increases in training intensity or volume 4