Treatment of Achilles Tendinopathy
Eccentric strengthening exercises combined with activity modification, ice, and footwear adjustments should be the immediate first-line treatment for Achilles tendinopathy, as this approach achieves full recovery in approximately 80% of patients within 3-6 months. 1, 2
Initial Treatment Protocol
Core Treatment Components
Eccentric strengthening exercises are the gold standard and most effective conservative treatment, working by stimulating collagen production and guiding normal alignment of newly formed collagen fibers. 1, 2, 3
Activity modification is mandatory: Reduce or eliminate activities causing pain while continuing activities that don't worsen symptoms—this prevents ongoing tendon damage. 1, 2
Gastrocnemius-soleus stretching exercises should be performed to improve flexibility and reduce tension on the tendon. 1, 2
Cryotherapy (ice therapy) provides short-term pain relief by reducing tissue metabolism and blunting inflammatory response. 1, 2
Footwear and Biomechanical Modifications
Open-backed shoes reduce pressure on the affected area, particularly important for insertional tendinopathy. 1, 2
Heel lifts or orthoses can unload the tendon and should be considered, especially if anatomic deformities exist (forefoot/heel varus, excessive pes planus, or foot pronation). 1, 2
Pain Management
NSAIDs (oral or topical) can be used for short-term pain relief, but should not be recommended over other analgesics for long-term management. 1, 2
Topical NSAIDs have fewer systemic side effects than oral formulations and should be preferred when NSAIDs are indicated. 1, 2
Treatment Duration and Progression Algorithm
Continue the initial treatment regimen for 6-8 weeks before considering more aggressive interventions. 1, 2
If improvement occurs, continue treatments until symptoms completely resolve. 1
If no improvement after 6-8 weeks, refer to a specialist for consideration of advanced interventions such as extracorporeal shockwave therapy or other modalities. 2
Critical Pitfall to Avoid
Never inject corticosteroids into the Achilles tendon—they inhibit healing, reduce tensile strength, and predispose to spontaneous rupture. 2
Insertional vs. Noninsertional Considerations
For insertional Achilles tendinopathy specifically (pain at the calcaneal attachment), the combination of eccentric exercise plus soft tissue therapy may be particularly effective for short-term pain control. 4
Prognosis
With early initiation of eccentric exercises and strict avoidance of pain-provoking activities, approximately 80% of patients achieve full recovery within 3-6 months. 1