What is the treatment for a calcified Achilles tendon?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 25, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Treatment for Calcified Achilles Tendon

Begin with a 6-8 week trial of conservative therapy consisting of eccentric strengthening exercises, calf stretching, heel lifts, open-backed shoes, activity modification, and NSAIDs for acute pain relief only—avoiding corticosteroid injections entirely due to rupture risk—and if symptoms persist after this period, refer for surgical debridement of the calcification. 1, 2

Understanding the Pathology

  • Calcified Achilles tendon represents a degenerative condition (tendinosis), not an inflammatory process (tendinitis), characterized by chronic collagen disorganization and calcium deposition at the insertion site. 2
  • This is why anti-inflammatory treatments provide only temporary symptomatic relief without addressing the underlying pathology. 1
  • Radiographs typically show spurring or erosion at the Achilles insertion, often with dorsal calcaneal enthesophytes (bone spurs). 1, 2

Initial Conservative Treatment (First 6-8 Weeks)

The American Academy of Family Physicians recommends the following stepwise approach: 1, 2

  • Eccentric strengthening exercises of the gastrocnemius-soleus complex—this has the strongest evidence for effectiveness and should be the cornerstone of treatment. 1, 2
  • Calf-muscle stretching and deep friction massage to address muscle tightness. 1
  • Heel lift orthotics to unload the tendon and reduce mechanical stress at the insertion site. 1, 2
  • Open-backed shoes to eliminate pressure on the posterior heel where calcification causes prominence. 2
  • Shoe orthotics if overpronation or pes planus is contributing to abnormal loading patterns. 1
  • Relative rest of the affected area with activity modification—not complete immobilization. 1
  • Icing for symptomatic relief. 1
  • NSAIDs for acute pain relief only—remember this is degenerative, not inflammatory, so long-term NSAID use is not indicated. 1, 2

Critical Pitfall: Avoid Corticosteroid Injections

  • Never inject corticosteroids into or around the Achilles tendon insertion—this is specifically contraindicated as it inhibits healing, reduces tensile strength, and significantly increases the risk of tendon rupture. 1, 2
  • The American Academy of Family Physicians and European League Against Rheumatism both warn against peritendinous Achilles injections. 1

Expected Conservative Treatment Outcomes

  • Approximately 80% of patients fully recover within 3-6 months with conservative outpatient treatment, justifying the initial trial period before considering surgery. 1, 2

Surgical Treatment (After Failed Conservative Therapy)

If no improvement after 6-8 weeks of conservative treatment, refer to a podiatric foot and ankle surgeon or orthopedic specialist. 1

Surgical options for significantly calcified insertional Achilles tendinopathy include:

  • Resection of intratendinous calcification and heel spur with reattachment of the Achilles tendon using suture anchors—this can be performed via posterior midline or lateral approaches. 3, 4
  • Debridement of the dorsal heel spur and Haglund deformity if present. 4
  • Gastrocnemius recession (Strayer procedure) should be performed simultaneously if gastrocnemius contracture is present, as this improves surgical outcomes. 3

Surgical outcomes are favorable, with studies showing 58% of patients achieving complete pain freedom and 42% reporting substantial improvement, with average VISA-A scores of 84/100 points. 4

Post-Surgical Rehabilitation

  • Initial immobilization in 20° plantar flexion for one week, followed by full weight-bearing in a walking boot with 4 cm heel lift for 6 weeks. 4
  • Gradual reduction of heel lift over 2 additional weeks, then transition to 1 cm elastic wedge. 4
  • Physical therapy with isometric exercises begins in the boot and intensifies after boot removal at 8 weeks. 4

Alternative Consideration: Immobilization

  • If conservative treatment shows minimal improvement at 6-8 weeks but surgery is not desired or feasible, consider an immobilization cast or fixed-ankle walker device as a bridge therapy. 1

References

1
Guideline

Ultrasound Therapy for Achilles Tendonitis Pain Relief

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

2
Guideline

Insertional Achilles Tendinopathy with Calcaneal Spur

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Research

Treatment of Calcified Insertional Achilles Tendinopathy by the Posterior Midline Approach.

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons, 2016

Related Questions

What is the recommended initial conservative treatment for Achilles tendinopathy?
What is the best treatment approach for a 16-year-old female with chronic Achilles tendon pain lasting over a year?
What is the treatment for an Achilles tendon tear?
What is the initial treatment for Achilles tendinopathy?
What is the best treatment approach for a 70-year-old patient with Achilles tendinitis, bilateral sacroillitis, and Chronic Kidney Disease (CKD) stage 3B?
What is the recommended management for acute sinusitis in a patient with mild symptoms lasting less than 10 days and no high‑grade fever, purulent nasal discharge, or worsening facial pain, including when to use antibiotics and which agents to choose?
What is the pathophysiology of the septic stress response?
What are the diagnostic criteria, assessment steps, and first‑line treatment (cognitive‑behavioral therapy and selective serotonin reuptake inhibitor) for hoarding disorder in adults?
How should I manage a 60‑year‑old Black female with total cholesterol 99 mg/dL, high‑density lipoprotein (HDL) 27 mg/dL, triglycerides 194 mg/dL, and non‑HDL cholesterol 72 mg/dL?
Do a blood urea nitrogen of 7 mg/dL, serum creatinine of 0.63 mg/dL, and estimated glomerular filtration rate of 114 mL/min/1.73 m² indicate normal renal function?
What is the most likely diagnosis and appropriate next steps for a 32‑year‑old female outpatient who presents 4 days after onset of dry cough worsened by fluids, thick white nasal discharge, congestion, heavy squeezing headache, one fever episode of 38 °C, sensation of phlegm stuck in throat, normal vital signs and physical examination, a history of recurrent cough episodes, and self‑medication with Lagundi, Bactidol mouthwash (chlorhexidine), phenylpropanolamine HCl + chlorpheniramine maleate (Symdex D), and vitamin C and zinc?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question