From the Guidelines
Treatment of Achilles tendinitis in a 67-year-old woman should begin with conservative measures, including relative rest, ice application, and over-the-counter NSAIDs like ibuprofen or naproxen for 1-2 weeks to reduce pain and inflammation. The most recent and highest quality study 1 recommends relative rest and reduced activity to prevent further damage and promote healing and pain relief. Some key points to consider in the treatment plan include:
- Gentle stretching exercises 2-3 times daily, holding each stretch for 30 seconds, focusing on the calf muscles and Achilles tendon
- A heel lift (approximately 1cm) in both shoes to reduce tension on the tendon
- Physical therapy for 6-8 weeks, incorporating eccentric strengthening exercises where the heel is slowly lowered from a raised position for 3 sets of 15 repetitions twice daily
- Night splints to maintain tendon flexibility during sleep
- Avoiding corticosteroid injections due to the increased risk of rupture, as noted in 1 and 1
- Considering a walking boot for 2-4 weeks for persistent pain
- Referral to an orthopedic specialist if conservative treatment fails after 3-6 months, as suggested in 1. It is essential to note that recovery is typically slower in older adults due to decreased tissue elasticity and blood flow, so patience with the rehabilitation process is crucial 1.
From the Research
Treatment Options for Achilles Tendinitis
The treatment for Achilles tendinitis in a 67-year-old woman can include various conservative and surgical options. Some of the conservative treatments that have been researched include:
- Nonsteroidal anti-inflammatory medication 2
- Eccentric exercise, which is considered one of the most effective treatments 2, 3
- Stretching 2
- Orthotics 2
- Bracing 2
- Glyceryl trinitrate patches 2
- Injection therapies (corticosteroids, hyaluronic acid, platelet-rich plasma injections) 2, 3
- Shock wave therapy, which is also considered an effective treatment 2, 3
- Low-level laser therapy 2
Effectiveness of Treatments
According to a living systematic review with network meta-analysis of 29 randomised controlled trials, any treatment class seemed superior to wait-and-see for midportion Achilles tendinopathy at 3 months 3. At 12 months, exercise therapy, exercise+injection therapy, and exercise+night splint therapy were all comparable with injection therapy for midportion tendinopathy 3.
Considerations for Treatment
It is essential to note that the effectiveness of treatments can vary depending on the individual and the severity of the condition. A study suggests that pain with physical tendon loading, time for pain to settle following aggravating activities, and time for the tendon to 'warm-up' following inactivity are the best indicators of the severity of disability in patients with Achilles tendinopathy 4. Clinicians can use these questions to assess baseline severity and monitor treatment response.