Achilles tendonitis treatment aims to reduce the pain, inflammation and stiffness so commonly associated with achilles tendonitis.
The achilles tendon is the largest and strongest tendon in the body but it is prone to damage by overuse, inflammation and degeneration.
Tendonitis is the most common cause of achilles heel pain. It can take months to recover fully, making early, effective achilles tendonitis treatment vital.
Here we will look at the causes, symptoms and different types of achilles heel pain, as well as a whole range of achilles tendonitis treatment options including prevention strategies the problem from coming back.
The achilles tendon is found on the back of the lower leg joining the two calf muscles, gastrocnemius and soleus, to the heel bone aka calcaneus.
The tendon is approximately six inches long. The muscle fibres run down the back of the calf, twist round through ninety degrees and then insert into the heel.
The achilles tendon is extremely strong and can withstand forces up to twelve times bodyweight, but it is not very flexible, making it prone to damage. It has an hour-glass type shape being wider at the top and bottom than in the middle.
Achilles heel pain most commonly develops due to repetitive stress through the tendon rather than from a specific injury. The tendon becomes fatigued and is unable to heal properly from the repetitive micro-trauma. The collagen fibres, that should be nicely aligned, begin to weaken and the crosslink’s between them break. The result is microscopic tears in the tendon.
Effective achilles tendonitis treatment depends on correctly
identifying the cause of the problem. Common causes of achilles tendonitis include:
Achilles tendonitis can develop in two places:
Effective achilles tendonitis treatment should target the specific location of the problem. Sometimes, the tendonitis can progress to tendonosis where there is no sign of inflammation, but instead degenerative lesions are seen.
The three main symptoms most commonly associated with achilles tendonitis are:
Your doctor can usually make an accurate diagnosis of achilles tendonitis from what you tell them and from examining your leg.
The doctor will get you push your foot down (plantarflexion) against resistance or rise up onto your tiptoes when standing. If this is painful, it indicates tendonitis. If you are unable to do this, it indicates a more severe injury, most likely a rupture of the tendon.
An x-ray may be performed if a calcaneal bone spur is suspected.
This helpful video from the American Academy of Orthopedic Surgeons looks at what happens if the tendon does completely rupture.
There are a number of different achilles tendonitis treatment options. Their main aims are to reduce the inflammation and irritation to the tendon. The best treatments for achilles tendonitis are:
Adequate rest is the most important part of achilles tendonitis treatment. The tendon must be given time to recover. Try as much as possible to avoid activities which provoke your symptoms. In severe cases, crutches may be required for a few weeks.
Wearing simple heel pads in your shoes can reduce the tension on the tendon - a simple yet effective Achilles tendonitis treatment. If altered foot biomechanics is thought to be contributing to your problem, an Orthotist can give you appropriate insoles to help correct the problem.
Using ice can help to reduce the pain and inflammation associated with tendonitis. However, if it is used incorrectly, it can actually make things worse. Visit the Ice Therapy section to find out how to apply ice safely and effectively.
Physiotherapy is a very important part of achilles tendonitis treatment. As well as giving you an exercise programme, your physiotherapist may carry out deep transverse frictions. This is a specific type of massage involving friction being applied transversely over the site of injury. I have had good success with patients using this. It may be followed by ultrasound treatment. Both help to improve blood flow to the area and realign the damaged fibres to promote healing.
Switching to activities such as swimming and cycling put much less strain on the achilles tendon than high impact activities like running and jumping.
Stretches should always be a part of achilles tendonitis treatment. If the calf muscles are tight, stretches will help to reduce the tension on the tendon. However, stretches should not be performed until resisted plantarflexion e.g. rising up onto your tiptoes, is pain-free otherwise further damage may occur.
Visit the calf stretches section to find out how to safely and effectively stretch the two calf muscles
Strengthening exercises are also an important part of achilles tendonitis treatment. By strengthening the calf muscles you can really help reduce the strain on the tendon.
Visit the calf workout section for a whole range of exercises to strengthen the calf muscles as part of your achilles tendonitis treatment.
If the condition has progressed to tendonosis, eccentric exercises over a course of three to four months are one of the most effective treatments. Eccentric exercises are when you work the muscle as it is relaxing and lengthening, rather than as it is contracting and shortening.
It is thought that they work by increasing the tensile strength and the length of the tendon, and causing hypertrophy where the tissues increase in volume, and she always be included as part of achilles tendonitis treatment.
Non-steroidal anti-inflammatories such as ibuprofen and naproxen can help reduce achilles pain, but will not reduce the thickening in the tendon caused by degeneration so this achilles tendonitis treatment must be carried out in conjunction with others.
Cortisone injections can be used to reduce pain and inflammation as part of achilles tendonitis treatment. The steroid tends to be peppered around the tendon, rather than inserted directly into the tendon to reduce the risk of the tendon rupturing.
Care must be taken for a few days following injections as they can temporarily weaken the tendon. You can find out more about steroid injections and how they work on our sister site.
Recovery from achilles tendonitis unfortunately tends to be slow. This is because the blood supply to the tendon is poor, reducing the circulation of the necessary oxygen and nutrients for healing.
It usually takes between three and six months of consistent achilles tendonitis treatment to fully recover. It is important to rest from aggravating activities to allow the tendon to heal.
Achilles tendonitis treatment should be started as soon as possible to prevent the condition getting worse.
Tendonitis can occur in a number of locations around the foot. Find out more about the causes, symptoms, diagnosis and treatment options in the foot and ankle tendonitis section.
Page Last Updated: 11/03/21
Next Review Due: 11/03/23