Management of Left Achilles Tendinitis
Begin with eccentric strengthening exercises as your primary treatment—this is the gold standard with the strongest evidence for effectiveness in Achilles tendinopathy. 1, 2, 3
Critical Terminology Note
The condition should be labeled "tendinosis" or "tendinopathy" rather than "tendinitis" because approximately 80% of cases involve chronic degenerative changes rather than acute inflammation. 1 This distinction matters because anti-inflammatory treatments alone will not address the underlying degenerative pathology. 1
Initial Treatment Protocol (First 6-8 Weeks)
Eccentric Strengthening Exercises:
- This is the most effective and popular treatment option with strong evidence, stimulating collagen production and guiding normal alignment of newly formed fibers. 1, 2
- Continue this as the cornerstone of your treatment plan throughout recovery. 3
Activity Modification:
- Reduce activities that cause pain while continuing activities that don't worsen symptoms to prevent ongoing damage. 2
- Implement relative rest of the affected area. 1
Stretching Program:
- Perform regular calf-muscle (gastrocnemius-soleus complex) stretching exercises to improve flexibility and reduce tendon tension. 1, 2
- Deep friction massage of the gastrocnemius-soleus complex is also helpful. 1
Orthotics and Footwear:
- Use over-the-counter heel cushions and arch supports to unload the tendon. 2
- Prescribe shoe orthotics to correct overpronation or pes planus problems, addressing underlying anatomic misalignment. 1
- Recommend heel lift orthotics specifically to unload the tendon for pain relief. 1
- Avoid flat shoes and barefoot walking; use open-backed shoes to reduce pressure on the affected area. 2
Cryotherapy:
- Apply ice for short-term pain relief to reduce tissue metabolism and blunt inflammatory response. 1, 2
NSAIDs for Pain Relief:
- Use oral or topical NSAIDs for acute pain relief, with topical formulations having fewer systemic side effects. 1, 2
- For naproxen specifically: start with 500 mg followed by 500 mg every 12 hours or 250 mg every 6-8 hours as required for acute tendonitis, with initial total daily dose not exceeding 1250 mg. 4
Critical Pitfall to Avoid
Never inject corticosteroids into or around the Achilles tendon. 5, 1, 2 These injections may inhibit healing, reduce tensile strength, and predispose to spontaneous tendon rupture. 2 For insertional Achilles tendinopathy specifically, local corticosteroid injections are explicitly contraindicated. 1, 2
If No Improvement After 6-8 Weeks
Refer to a podiatric foot and ankle surgeon while continuing all initial treatment measures. 1, 2
Add Secondary Interventions:
- Customized orthotic devices to correct biomechanical issues. 2
- Night splinting to maintain tendon length. 2
- Immobilization with cast or fixed-ankle walker device for particularly acute or refractory cases. 1, 2
- Physical therapy interventions (land-based preferred over aquatic). 2
For Refractory Cases (After 2-3 Months of Conservative Treatment)
- Consider cast immobilization if not previously used. 2
- Extracorporeal shock wave therapy for recalcitrant cases. 2, 6
- Surgical intervention as a last resort. 2, 7
Expected Outcomes
Approximately 80% of patients fully recover within three to six months with conservative outpatient treatment. 1 Continue treatments until symptoms resolve if improvement occurs. 2
Special Biomechanical Considerations
Pay attention to anatomic deformities such as forefoot and heel varus, excessive pes planus, or foot hyperpronation, as these biomechanical factors often contribute to development and persistence of Achilles tendinopathy. 2 Weight loss should be considered if indicated. 2