From the Guidelines
Imaging is not typically necessary for diagnosing Achilles tendinitis with a palpable lump, as the diagnosis can often be made based on clinical presentation and history. The condition is often characterized by gradually increasing load-related localized pain coinciding with increased activity, and examination should include thorough inspection, range-of-motion testing, palpation for tenderness, and examination maneuvers that simulate tendon loading and reproduce pain 1.
Key Points to Consider
- Most patients with overuse tendinopathies, including Achilles tendinitis, fully recover within three to six months with conservative treatment consisting of relative rest, icing, and eccentric strengthening exercises 1.
- Initial management should focus on conservative treatments including rest, ice application, compression, and elevation (RICE protocol), as well as non-steroidal anti-inflammatory drugs for pain and inflammation management.
- Physical therapy exercises, particularly eccentric heel drops, are crucial for recovery and should be performed for 12 weeks.
- Imaging, such as ultrasound or MRI, may become necessary if symptoms persist despite 6-8 weeks of conservative treatment, if there's suspicion of a partial or complete tendon rupture, or if the lump changes in size or character 1.
Treatment Approach
- Conservative treatment should be the first line of approach, with surgery reserved for patients who have failed conservative therapy 1.
- Topical and systemic nonsteroidal anti-inflammatory drugs can be effective for acute pain relief, but should be used with caution 1.
- Injected corticosteroids can also relieve pain, but should be used with caution due to potential side effects 1.
From the Research
Imaging for Achilles Tendinitis
- Imaging may be necessary to confirm the diagnosis of Achilles tendinitis and to rule out other potential causes of symptoms 2
- Ultrasound and magnetic resonance imaging (MRI) are useful in assisting in the diagnosis of Achilles tendinopathy, with MRI providing slightly better sensitivity and specificity 3
- Ultrasound scans might be useful in predicting future Achilles tendinopathy occurrences 3
Diagnosis of Achilles Tendinitis
- 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 for diagnosis 3
- At least 10 simple clinical tests are available for the diagnosis of Achilles tendinopathy, but accuracy and reproducibility vary 3
Treatment of Achilles Tendinitis
- Conservative first-line therapy includes reduction of activity levels, administration of non-steroidal anti-inflammatory drugs (NSAID), adaptation of footwear, heel wedges and orthoses or immobilization 4
- Eccentric stretching exercises should be integral components of physiotherapy and can achieve a 40% reduction in pain 4
- Extracorporeal shock wave therapy has been shown to reduce pain by 60% with a patient satisfaction of 80% 4
- Operative therapy is indicated after 6 months of unsuccessful conservative therapy 4