What is the treatment for calcium Achilles tendinosis?

Treatment for Calcium Achilles Tendinosis

The treatment for calcium Achilles tendinosis should begin with conservative measures including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss if indicated, while specifically avoiding corticosteroid injections into the Achilles tendon. 1

Initial Conservative Management

• Open-backed shoes to reduce pressure on the affected area 1
• Heel lifts or orthotic devices to reduce tension on the Achilles tendon 1
• NSAIDs for pain management and potential anti-inflammatory effects 1
• Activity modification and relative rest to prevent ongoing damage 1, 2
• Regular calf muscle stretching exercises 1, 3
• Eccentric strengthening exercises, which have shown particularly promising results in Achilles tendinopathy 1, 3
• Cryotherapy (ice) applied through a wet towel for 10-minute periods to provide short-term pain relief 1
• Weight loss if the patient is overweight 1

Important Caution

• Local corticosteroid injections into the Achilles tendon are NOT recommended due to risk of tendon weakening and potential rupture 1
• Corticosteroids may inhibit healing and reduce tensile strength of the tissue 1

If No Improvement After 6-8 Weeks

If symptoms do not improve after 6-8 weeks of conservative treatment:

• Referral to a podiatric foot and ankle surgeon is appropriate 1
• Continue initial treatments while adding:
  • Immobilization with a cast or fixed-ankle walker-type device 1
  • Consideration of customized orthotic devices 1

Advanced Treatment Options

For cases that fail to respond to 3-6 months of conservative therapy:

• Extracorporeal shock wave therapy (ESWT) may be considered, though results are mixed and there are potential complications including tendon rupture 4
• Surgical options may include:
  • Debridement of the diseased area of the tendon with direct repair 5
  • Tendon transfer may be necessary in some cases to augment strength 5

Diagnostic Considerations

When evaluating calcium Achilles tendinosis:

• Plain radiography may show calcific tendinosis, calcaneal avulsion fracture, or soft tissue swelling 1
• Ultrasound can demonstrate tendon thickening and heterogeneous echogenicity 1
• MRI is useful for showing partial tendon tears, tendon thickening, bursitis, and chronic degenerative changes 1

Treatment Algorithm

1. Begin with 6-8 weeks of conservative treatment (open-backed shoes, orthoses, NSAIDs, activity modification, stretching, eccentric exercises)
2. If improvement occurs, continue treatment until symptoms resolve 1
3. If no improvement after 6-8 weeks, refer to specialist and consider immobilization 1
4. If no improvement after 3-6 months of comprehensive conservative care, consider ESWT or surgical options 1, 5

Evidence Strength and Considerations

• Eccentric exercise training has the strongest evidence and is considered the gold standard for Achilles tendinopathy treatment 3
• While ESWT is generally considered safe, physicians should be aware of potential major complications including tendon rupture 4
• The short-term results after surgical treatment are frequently very good, but long-term follow-up studies suggest possible deterioration over time 2
• Calf muscle strength takes a long time to recover after surgical intervention 2