Treatment of Achilles Tendonitis
Start with eccentric strengthening exercises combined with calf-muscle stretching as your primary treatment—this has the strongest evidence for effectiveness and should be the foundation of your management approach. 1
Initial Conservative Treatment (First 6-8 Weeks)
The condition should be labeled as "tendinosis" or "tendinopathy" rather than "tendonitis" because approximately 80% of cases involve chronic degenerative changes rather than acute inflammation. 1 This distinction is critical because it means anti-inflammatory treatments alone will not address the underlying pathology. 1
Core Treatment Components:
Eccentric strength training is the most effective treatment option with strong evidence supporting its use—this should be your primary intervention. 1
Calf-muscle stretching of the gastrocnemius-soleus complex is essential and should be performed regularly. 2, 1
Heel lift orthotics to unload the tendon and provide immediate pain relief. 1
Shoe orthotics to correct overpronation or pes planus problems if anatomic misalignment is present. 1
Relative rest of the affected area with activity modification—not complete immobilization. 1
NSAIDs for acute pain relief only, not as primary treatment since the pathology is degenerative. 1
For Insertional Achilles Tendinopathy Specifically:
Open-backed shoes to reduce pressure on the posterior heel insertion site. 2, 3
Deep friction massage may be helpful as an adjunctive treatment. 1
Patients typically experience relief when walking barefoot and worsening with shoe pressure. 2
Critical Pitfall to Avoid
Never inject corticosteroids into or around the Achilles tendon—this is specifically contraindicated due to high risk of tendon rupture and weakening. 2, 1, 3 This applies to both insertional and non-insertional tendinopathy. 2, 1 Corticosteroids inhibit healing and reduce tensile strength of the tissue. 3
If No Improvement After 6-8 Weeks
Refer to a podiatric foot and ankle surgeon for specialized evaluation. 2, 1
Continue all initial treatment measures. 2
Consider immobilization cast or fixed-ankle walker device for refractory cases. 2, 1
Night splinting may be added to the treatment regimen. 2
If No Improvement After 3-6 Months
Approximately 80% of patients fully recover within three to six months with conservative outpatient treatment. 1 For the remaining 20%:
Continue conservative measures with cast immobilization if not previously used. 2
Consider extracorporeal shock wave therapy as it has high evidence-based effectiveness. 4, 5
Surgical options (tendon debridement, calcaneal exostosis ostectomy, retrocalcaneal bursa excision) may be indicated after comprehensive conservative care has failed. 2, 6, 5
Address Underlying Causative Factors
Treatment will fail if you don't correct the biomechanical problems driving the condition:
Overtraining is present in approximately 75% of cases and must be addressed. 7
Functional overpronation occurs in approximately 56% of cases and requires orthotic correction. 7
Gastrocnemius/soleus insufficiency is present in approximately 38% of cases and necessitates strengthening exercises. 7
Improper training techniques and biomechanical abnormalities must be corrected to prevent recurrence. 8, 7