What is the recommended treatment for Achilles tendinitis?

Treatment of Achilles Tendinitis

Begin with eccentric strength training as your primary treatment—this is the most effective intervention with the strongest evidence for Achilles tendinopathy. 1, 2, 3

First-Line Conservative Management (0-8 Weeks)

The initial treatment approach should include the following components simultaneously:

Core Interventions

• Eccentric strengthening exercises are the gold standard and most effective treatment option, with universal acceptance across guidelines and research 1, 2, 3
• Stretching of the gastrocnemius-soleus complex should be performed regularly to address muscle tightness and reduce tendon loading 1, 2, 4
• Deep friction massage of the calf muscles is recommended to reduce pain and promote healing 1, 2

Mechanical Modifications

• Heel lift orthotics should be used to unload the tendon and provide immediate pain relief 1, 2, 4
• Shoe orthotics are necessary if anatomic misalignment exists, particularly for correcting overpronation or pes planus deformities 1, 2, 4
• Open-backed shoes reduce direct pressure on the posterior heel in insertional cases 4

Adjunctive Measures

• Relative rest with activity modification is fundamental—avoid activities that reproduce pain while maintaining general fitness 2, 5, 6
• Ice/cryotherapy provides short-term pain relief 2, 4, 6
• NSAIDs can be used for acute pain management, though recognize the underlying pathology is degenerative rather than inflammatory 2, 4, 6

Critical Terminology Note

This condition should be labeled as "tendinosis" or "tendinopathy" rather than "tendinitis" because approximately 80% of cases involve chronic degenerative changes rather than acute inflammation 2. This distinction matters because anti-inflammatory treatments alone will not address the underlying pathology 2.

When Initial Treatment Fails (6-8 Weeks)

If no improvement occurs after 6-8 weeks of comprehensive conservative treatment:

• Refer to a podiatric foot and ankle surgeon or sports medicine specialist 2
• Continue all initial treatments while awaiting specialist evaluation 2
• Consider immobilization with a cast or fixed-ankle walker device 2, 4

What NOT to Do: Critical Safety Warning

Never inject corticosteroids into or around the Achilles tendon—this significantly increases the risk of tendon rupture. 2, 4, 6

• Local corticosteroid injections are specifically contraindicated for Achilles tendinopathy 2, 4
• Corticosteroids inhibit healing and reduce tensile strength of the tissue 4
• This applies to both insertional and non-insertional Achilles tendinopathy 2

Expected Outcomes

Approximately 80% of patients achieve full recovery within 3-6 months with conservative outpatient treatment 2. Surgery should only be considered for chronic cases unresponsive to 3-6 months of comprehensive conservative care in patients who wish to continue high-level activities 4, 5, 6.

Common Pitfalls to Avoid

• Don't rely on NSAIDs alone—they provide symptomatic relief but don't address the degenerative pathology 2
• Don't ignore biomechanical factors—training errors, improper footwear, anatomic misalignment, and muscle weakness/inflexibility must be corrected to prevent recurrence 1, 6
• Don't pursue therapeutic ultrasound as primary treatment—stick with evidence-based interventions (eccentric exercises, stretching, orthotics) that have proven efficacy 2
• Don't overlook anatomic deformities—specifically assess for forefoot and heel varus, excessive pes planus, and foot overpronation 1