From the Guidelines
Treatment for severe Achilles tendinosis with bursal distension should prioritize a comprehensive approach combining rest, physical therapy, and possibly medical interventions, with eccentric strength training being a particularly effective option, as recommended by the American Family Physician in 2005 1.
Key Components of Treatment
- Reduce activities that aggravate symptoms and implement the RICE protocol (Rest, Ice, Compression, Elevation)
- Non-steroidal anti-inflammatory drugs like naproxen or ibuprofen for 1-2 weeks to manage pain and inflammation
- Physical therapy focusing on eccentric strengthening exercises, such as heel drops, performed 3 sets of 15 repetitions twice daily for at least 12 weeks
- Consider extracorporeal shockwave therapy for persistent cases, typically administered once weekly for 3-5 sessions
- Corticosteroid injections directly into the bursa (not the tendon) for significant bursal distension, limited to avoid tendon weakening
- Platelet-rich plasma injections as an alternative, usually requiring 1-3 treatments spaced 4-6 weeks apart
- Night splints to maintain ankle dorsiflexion during sleep and proper footwear with adequate arch support as supportive measures
Surgical Options
In severe cases unresponsive to conservative treatment for 6 months, surgical options including debridement, tendon repair, or bursal excision may be necessary, as suggested by the American College of Foot and Ankle Surgeons in 2002 1.
Recovery and Prognosis
Recovery typically requires patience, as Achilles tendinosis healing can take 3-6 months due to the tendon's limited blood supply and high mechanical stress during daily activities. It is essential to prioritize a comprehensive and conservative approach to minimize the risk of complications and promote optimal outcomes.
From the Research
Treatment Options for Severe Achilles Tendinosis and Bursal Distension
- Conservative treatment options include:
- Reduction of activity levels
- Administration of non-steroidal anti-inflammatory drugs (NSAID) 2, 3, 4
- Adaptation of footwear, heel wedges, and orthoses or immobilization 2
- Eccentric stretching exercises, which can achieve a 40% reduction in pain 2
- Extracorporeal shock wave therapy, which has been shown to reduce pain by 60% with a patient satisfaction of 80% 2
- Surgical treatment options include:
- Open debridement, which allows all pathologies to be addressed, including osseous abnormalities and intratendinous necrosis, with a success rate of over 70% 2
- Tendoscopy, which is a promising treatment option for isolated retrocalcaneal bursitis and has shown similar success rates to open debridement with significantly lower complication rates 2
- Debridement of the diseased area of the tendon with direct repair, and tendon transfer may be necessary to augment the strength of the Achilles tendon 3
Diagnostic Tools
- Magnetic resonance imaging (MRI) and ultrasound are helpful in confirming the diagnosis and guiding treatment 3, 4
- Patient self-reports of morning stiffness and/or pain in the tendon area, pain on palpation of the tendon, and detection of Achilles tendon thickening appear to be the most useful clinical tests 4