Treatment of Chronic Achilles Tendinopathy in a 16-Year-Old Female
Eccentric strengthening exercises are the gold standard treatment and should be the cornerstone of management for this adolescent with chronic Achilles tendinopathy. 1, 2
Initial Conservative Management Algorithm
First-Line Treatment (Weeks 0-8)
Eccentric Exercise Protocol
- Eccentric strengthening exercises are the most effective conservative option, stimulating collagen production and guiding normal alignment of newly formed collagen fibers 3, 1
- This is universally accepted as the gold standard treatment for Achilles tendinopathy 2
- These exercises have proven beneficial specifically for Achilles tendinosis in multiple studies 3
Activity Modification
- Reduce activities that reproduce her pain to prevent ongoing damage 1
- Continue activities that don't worsen symptoms to avoid muscular atrophy and deconditioning 3
- Complete immobilization should be avoided as tensile loading stimulates proper tendon healing 3
Adjunctive Therapies
- Stretching exercises for the gastrocnemius-soleus complex improve flexibility and reduce tendon tension 1
- Cryotherapy through a wet towel for 10-minute periods provides short-term pain relief 3, 1
- Open-backed shoes reduce pressure on the affected area 1
- Heel lifts or orthoses can unload the tendon 1
Pain Management
NSAIDs for Symptom Control
- Topical or oral NSAIDs effectively relieve tendinopathy pain 3, 1
- Topical NSAIDs eliminate the increased risk of gastrointestinal hemorrhage associated with systemic NSAIDs 3
- These provide short-term relief but don't alter long-term outcomes 1
Critical Pitfall to Avoid
Never inject corticosteroids into or around the Achilles tendon - they may inhibit healing, reduce tensile strength, and predispose to spontaneous rupture 3, 1
Biomechanical Assessment
Evaluate for anatomic deformities that perpetuate the condition 1:
- Forefoot and heel varus
- Excessive pes planus
- Foot pronation
- Consider orthotics to correct these biomechanical problems 3
Treatment Duration and Progression
- Continue initial conservative treatment for 6-8 weeks before considering more aggressive interventions 1
- If improvement occurs, continue treatments until symptoms completely resolve 1
- Given the one-year duration of symptoms in this patient, expect a prolonged treatment course of several weeks to months 4
When to Refer
Consider specialist referral if no improvement occurs after 6-8 weeks of conservative treatment 1, or if symptoms remain recalcitrant after 3-6 months of appropriate conservative therapy 5
Special Considerations for Adolescents
At age 16, this patient is still potentially growing, making conservative management even more critical to avoid surgical complications and preserve long-term athletic development 6. The conservative approach leaves open the option of surgical treatment if needed while maintaining excellent recovery potential 6.