From the Guidelines
Achilles tendonitis should be treated with relative rest, icing, and eccentric strengthening exercises, as most patients fully recover within three to six months with these measures. For treatment, start with the RICE method: Rest the affected area, apply Ice for 15-20 minutes several times daily, use Compression with an elastic bandage, and Elevate your foot when possible. Take over-the-counter pain relievers like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily) to reduce pain and inflammation, as suggested by 1. Gentle stretching exercises, particularly calf stretches held for 30 seconds and repeated 3-5 times daily, can help recovery. Supportive footwear with proper arch support and heel cushioning is essential, and temporary heel lifts (about 1cm) can reduce tendon strain, as recommended by 1.
Some key points to consider in the treatment of Achilles tendonitis include:
- Avoiding injected corticosteroids, as they should be used with caution 1
- Considering ultrasonography, shock wave therapy, orthotics, massage, and technique modification as treatment options, although few data exist to support their use at this time 1
- Reserving surgery for patients who have failed conservative therapy, as it is an effective treatment option 1
- Gradual return to activities and preventative stretching can help avoid recurrence once symptoms improve.
It is also important to note that Achilles tendonitis is often a degenerative condition, rather than an inflammatory one, and should be labeled as "tendinosus" or "tendinopathy" 1. Accurate diagnosis requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems.
From the Research
Definition and Prevalence of Achilles Tendinopathy
- Achilles tendon-related pain affects up to 6% of the US population during their lifetime 2
- Achilles tendinopathy is a common overuse condition characterized by degenerative, cumulative tissue microtrauma 3
Symptoms and Diagnosis
- Patients typically present with localized pain that is worse with tendon-loading activities 3
- Imaging modalities may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures 3
Management Options
- Conservative management options for chronic Achilles tendinopathy include:
- Eccentric (lengthening) exercises
- Extracorporeal shockwave therapy (ESWT)
- Topical nitroglycerin
- Low level laser therapy
- Orthoses
- Splints or injections (e.g. corticosteroids, hyperosmolar dextrose, polidocanol, platelet-rich plasma) 4
- Surgical treatment is recommended when nonsurgical treatment fails 5
Treatment of Insertional Achilles Tendinopathy
- Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy 5
- Surgical treatment options include preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment, calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer 5