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Treatment Options for Achilles Tendon Injuries

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Updated May 30, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Options Available for Treatment of the Achilles Tendon:

The best treatment of Achilles tendon problems is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint. Problems with foot mechanics can also be treated with devices inserted into the shoes. Products such as heel cups, arch supports, and custom orthotics can be used to correct for abnormalities, such as overpronation, and help prevent Achilles tendon injuries.

Rest:

Resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling acute Achilles tendon injuries.

Immobilization:

In patients who have more significant or more chronic symptoms, a period of immobilization can help. Either a removable walking boot, or sometimes even a cast, can allow the inflamed tissue to cool down quickly. The length of time of immobilization should be limited to prevent stiffness or muscle atrophy, but this can be an effective method of quickly relieving inflammation.

Shoe Inserts:

A heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic shoes and work shoes. By lifting up the heel of the foot, even by a small amount, a significant amount of force is decreased on the Achilles tendon.

Ice Application:

Applying ice to the area of inflammation can help stimulate blood flow to the area and relieve the pain associated with inflammation. Apply ice after exercise, as well as several other times over the course of the day. Treatments targeted at controlling inflammation will only help in the treatment of acute inflammatory Achilles tendonitis, not chronic Achilles tendinosis.

Anti-Inflammatory Medications:

Nonsteroidal anti-inflammatory medications include a long list of possibilities such as ibuprofen, Motrin, Naprosyn, Celebrex, and many others. These medications help to control inflammation in and around the tendon. As stated above, anti-inflammatories are more helpful when treating Achilles tendonitis, rather than chronic Achilles tendinosis.

A newer type of anti-inflammatory medication that is applied topically as a gel is also often used for the treatment of Achilles tendonitis. Topical anti-inflammatory medications may also be helpful in situations where there is inflammation present causing the pain.

Physcial Therapy:

Physical therapy consisting of stretching and specific strengthening exercises that are probably the most helpful treatments for those with Achilles tendon problems. Ensuring adequate flexibility of the muscles of the calf is one priority. Strengthening of these muscles, specifically eccentric strengthening exercises, have been shown to help with chronic tendon problems.

PRP and Cortisone Injections:

Injections can be used for the treatment of Achilles tendon problems, but these are generally avoided because of lack of effectiveness and possible complications. PRP injections have not been shown to help in the treatment of Achilles tendon problems, and cortisone injections can lead to possible rupture of the Achilles tendon. Therefore, injections are used sparingly in the treatment of Achilles tendon problems.

Surgery:

Surgery is usually considered only after a lengthy trial of nonsurgical treatments have been exhausted. Most people can find relief with nonsurgical treatments. Options for surgery include removing the damaged portion of tendon (debridement), lengthening of the tendon, or moving the tendon attachment.

Sources:

Saltzman CL, Tearse DS. "Achilles tendon injuries" J. Am. Acad. Ortho. Surg., Sep 1998; 6: 316 - 325.

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