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, 2, 3

First-Line Treatment Approach

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

Important Cautions and Contraindications

• AVOID corticosteroid injections into or around the Achilles tendon as they may inhibit healing, reduce tensile strength, and predispose to spontaneous rupture 1, 2
• For insertional Achilles tendinitis specifically, local corticosteroid injections are not recommended 1
• 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, 2

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

• Refer to a podiatric foot and ankle surgeon if no improvement occurs after 6-8 weeks of conservative treatment 1
• Consider customized orthotic devices to correct biomechanical issues 1
• Implement night splinting to maintain tendon length 1
• Consider immobilization with cast or fixed-ankle walker-type device for particularly acute or refractory cases 1
• Physical therapy interventions (land-based preferred over aquatic) may provide additional benefit 1

Advanced Treatment Options (for refractory cases)

• For cases not responding after 2-3 months of conservative treatment, consider:
  • Cast immobilization if not previously used 1
  • Extracorporeal shock wave therapy (ESWT) for recalcitrant cases 1, 4
  • Newer treatments such as platelet-rich plasma (PRP) injections show promising results similar to ESWT in some studies 4
  • Surgical intervention as a last resort 1

Monitoring and Follow-up

• Continue treatments until symptoms resolve if improvement occurs 1
• Regularly assess pain levels, range of motion, and functional capacity 1
• Most patients should see improvement within 6-8 weeks with appropriate conservative management 1, 2

Special Considerations

• For bursitis associated with Haglund's deformity, use open-backed shoes, orthoses, and accommodative padding 1
• Evidence for other treatments such as low-dose heparin, heel pads, and topical laser therapy is weak and inconclusive 5
• Emerging research on injectable celecoxib nanoparticle hydrogels shows promise for long-term anti-inflammatory effects but requires further clinical validation 6