Treatments for the Achilles Tendon

Options Available for Treatment of the Achilles Tendon

achilles stretch
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The best treatment of an injury to the Achilles tendon is to focus on prevention. Obviously, it's best to avoid injuries all together, but even in the setting of a problem with the Achilles, one of the most important aspects of treatment is to prevent progression and recurrence of the injury.

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.

Physical 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.

Eccentric strengthening exercises are specific activities and movements that allow for muscle contraction while the muscle is lengthening. This may sound strange, most often when the muscle contracts, it shortens. However, there are specific activities that allow for muscle lengthening while contracting. These types of exercises have been shown to be important in tendon healing and can promote improved tendon function. A physical therapist or athletic training can help to teach you some specific activities that can help improve your Achilles tendon function.

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. While surgery can be effective, the reality is the vast majority of people with Achilles tendon injuries can find relief with noninvasive treatments. Surgery is typically only considered for individuals who have tried, and failed, the aforementioned treatments for at least 6 months, if not longer.

Sources:

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

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