From the Guidelines
Treatment for Achilles tendonitis should primarily consist of relative rest, icing, and eccentric strengthening exercises, as most patients fully recover within three to six months with conservative therapy. When managing Achilles tendonitis, it's essential to recognize that the condition is often degenerative rather than inflammatory, and thus, the approach should focus on addressing the underlying tendinopathy rather than just the symptoms 1. The initial steps include reducing activities that exacerbate the pain and applying the RICE protocol: Rest, Ice, Compression, and Elevation.
For pain management, over-the-counter NSAIDs like ibuprofen or naproxen can be used for acute pain relief, but their long-term use should be cautious due to potential side effects 1. Physical therapy is crucial, with exercises such as gentle stretching of the calf muscles and eccentric heel drops being particularly beneficial. Eccentric strength training has been shown to be an effective option for Achilles tendinopathy, helping to strengthen the tendon and improve function 1.
Additionally, addressing anatomic misalignments with shoe orthotics to correct issues like overpronation or pes planus, and using heel lift orthotics to unload the tendon, can provide significant pain relief 1. It's also important to ensure supportive footwear with proper arch support and heel cushioning. Most cases of Achilles tendonitis improve within 6-12 weeks with consistent conservative treatment, but if pain persists or worsens, further medical evaluation may be necessary to consider other treatment options like corticosteroid injections or surgery.
From the FDA Drug Label
For relief of the signs and symptoms of tendonitis The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
Treatment for Achilles Tendonitis:
- The recommended dose of naproxen for tendonitis is 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
- The initial total daily dose should not exceed 1250 mg of naproxen, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2, 2.
- Key Considerations:
- Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
- Naproxen may be used for relief of the signs and symptoms of tendonitis.
- Patients with renal or hepatic impairment or elderly patients may require a lower dose. 2
From the Research
Treatment Options for Achilles Tendinopathy
- Conservative treatment is often the first line of treatment for Achilles tendinopathy, with a focus on activity modification and rehabilitation, including progressive tendon-loading exercises 3, 4, 5.
- Eccentric exercise training is considered the gold standard for conservative treatment of Achilles tendinopathy 5.
- Other conservative treatment options include pharmacologic treatment, physical therapy, and injections, such as platelet-rich plasma (PRP) injections 4, 6, 7.
- Surgical intervention may be considered in recalcitrant cases or in cases where conservative treatment has failed 3, 4.
Efficacy of Platelet-Rich Plasma (PRP) Injections
- The efficacy of PRP injections for treating Achilles tendonitis is still a topic of debate, with some studies suggesting a significant improvement in symptoms, while others have found no significant difference between treatment and control groups 6, 7.
- A systematic review of high-quality randomized controlled trials found no significant differences between PRP treatment and control groups, although PRP has important clinical significance for treating Achilles tendonitis 7.
- Another systematic review found that while many retrospective studies suggested an advantage of using PRP, the higher level of evidence studies do not support a significant efficacy 6.
Rehabilitation and Prevention
- Rehabilitation for Achilles tendinopathy typically involves a focus on progressive tendon-loading exercises, with the goal of improving tendon strength and function 3, 5.
- Prevention of Achilles tendinopathy involves addressing causative factors, such as improper training or biomechanical abnormalities, and incorporating exercises to strengthen the tendon and surrounding muscles 4.