How is Achilles tendonitis treated?
The goal of treatment is initially to reduce the inflammation .
To do this, the affected ankle must be immobilized so that the micro-injuries can heal.
For the first two days it is helpful to apply ice packs 3 times a day for 20 minutes.
To avoid re-irritating the affected area, ask other people for help and/or use supports to perform painful movements if necessary.
If activities that cause pain continue to be carried out at work or in sports, there is a risk that the lesions will worsen until the tendinitis becomes chronic.
Sometimes these measures are sufficient to completely heal an Achilles tendonitis .
Medicines for Achilles tendonitis
There are different types of medication used to treat Achilles tendonitis.
The doctor may prescribe pain relievers, such as acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Dolormin) and diclofenac (Voltaren), but these can cause side effects, such as abdominal discomfort or stomach ulcers .
These drugs are effective in relieving pain; they can also be applied to the affected area in the form of cream or gel.
If the symptoms of tendinitis last for more than 2 months, cortisone-containing drugs can be injected directly into the tendon.
These drugs can be very effective because they are powerful pain relievers, but the effects are not permanent unless the tendon is sedated.
Caution: cortisone can have serious effects in diabetes because it makes it difficult to regulate insulin levels; it can also weaken the tendons, putting them at risk of tearing. A doctor’s prescription is required
to take cortisone .
Physiotherapy for Achilles tendonitis
Manipulation is one of the most effective therapies because it helps to release the blockage in the ankle joint and stimulates blood flow, which makes healing possible.
The classic massage of the calf is less effective.
Some publications speak of good results with shock waves for the Achilles tendon; one study compared runners and non-sportspeople; the athletes had a higher percentage of healing.
A measure that shows excellent results in the treatment of tendinopathy of the Achilles tendon is the use of an orthopedic insole ; if done correctly, this reduces stress and overstretching of the tendon and promotes a functional resting position.
After ankle tendinitis, muscle strengthening is of the utmost importance because people with a strong calf do not develop this type of tendinitis.
The conditions where shock wave therapy shows best results are enthesitis , heel spurs and non-union .
Physiotherapy techniques such as laser , ultrasound and shock wave therapy can be helpful in relieving swelling and pain because of their anti-inflammatory effects.
Tecar therapy does not help with tendonitis.
Usually these applications have a long-term effect.
To relieve the tendon, we recommend using an ankle bandage or kinesio taping .
Manual therapy is very effective in treating tendonitis; Cyriax and myofascial manipulations are particularly suitable because they remove adherences and fibrosis of the tendon.
When the pain subsides, an exercise program to strengthen the tendon-muscle unit can be followed.
Tendon stretching exercises are discouraged because they temporarily increase pain and may not cure tendonitis.
Natural cures for Achilles tendonitis
Taping for Achilles tendonitis
Effect: draining. Shape: an ”I” stripe. Length: 25-30cm. Keep the foot in a neutral position and place the band under the heel. Pull the foot up and apply the tape without tension; follow the course of the Achilles tendon.
To relieve the tendon swelling, arnica ointment can be applied or a clay pack applied; however, these measures are not sufficient for healing because the inflammation persists as long as the tendon fibers are damaged.
Some studies have compared the results of different muscle strengthening procedures for tendon degeneration and have found that eccentric exercises are more effective than conventional physical therapy treatments. In these exercises, the muscle is stretched under load (the muscle is stretched while being contracted). The opposite happens with concentric exercises: the muscle shortens during contraction, the “classic” method of strength training.
With isometric exercises, the muscle length remains constant, the body is not moved and has to counteract a force.
Eccentric calf exercises have been shown to have a great effect in Achilles tendon treatment. When the patient no longer feels pain while doing the exercises, the load can be increased. Undesirable side effects may occur, such as muscular numbness or worsening of the inflammation.
These effects become noticeable when the exercises are performed too quickly, incorrectly or with too much weight.
There are two types of exercises: the first with the knees straight (activation of the calf biceps), and the second with flexion (activation of the soleus).
- Heel drop with locked knees: stand upright with the front part of the foot on a step, heel pointing up initially; then lower the heel until the foot is straight and parallel to the floor.
- Heel drop with bent knees: stand on a step as in the previous exercise, but this time the knees form a 45° angle; lower the heel until the foot is straight and parallel to the floor.
When the heel is down, the other leg must always be used to return to the starting position (to limit concentric muscle tension). The hands may be used to help stabilize the body before and during the exercise.
These exercises should be performed in 3 sets of 15 repetitions (3×15), twice a day, 7 days a week.
Do the exercises until the pain is gone; only use your own body weight. Once the pain has completely subsided, the load can be slowly increased with the help of dumbbells and barbells.
- Stand upright in front of a wall, one leg in front of the other. The toes of the front foot touch the wall. Shift your weight to the front foot. Now bend your knee and try to touch the wall. If you have succeeded, move back a few centimeters and push forward again. Maintain an upright posture during the exercise. Do 3 sets of 10 repetitions for each leg.
- Calf machine (fitness equipment, also called calf machine): place the front foot on the edge of the tread, upright posture, feet are shoulder-width apart. With the shoulder weight on, lower your heels under the tread. Then pull back up to step level to complete the exercise. Do 2 sets of 10 reps each.
- Fitness band: sit down, pull up one leg, stretch out the other to the front. Wrap the band around the foot of the outstretched leg. Point your toes forward, away from your body. Now pull the band towards your body while allowing your toes to come back into neutral position; always resist the movement. Do 3 sets of 12 repetitions for each leg.
Running and ball sports (tennis, soccer, basketball, etc.) should be avoided until symptoms have completely disappeared.
Cycling is possible, but climbs and sprints should be avoided; the foot should be placed as far forward as possible on the pedal; kicking with the toes puts a much heavier strain on the tendon than kicking with the heel.
Surgery for Achilles tendonitis
Surgery is not a common solution for tendonitis, but in some cases, surgery to treat tendonitis and calcifications can be useful.
If the surgeon speaks of a tenosynovialectomy, this means the removal of the tendon sheath. The tendon sheath secretes synovial fluid, which is important for lubricating the joint, but when the amount of fluid is too much, the tendon sheath swells.
Another intervention consists in the arthroscopic removal of the calcium deposits ; it does not require long follow-up treatment.
How long does recovery take? The healing prognosis
Traumatic tendinitis heals faster than one caused by overuse.
If the affected person continues to do the repetitive activities that triggered the tendonitis, the inflammation cannot heal and becomes chronic.
Acute inflammation should heal within a month with rest and physical therapy.
Chronic tendonitis takes longer to heal, but with appropriate treatment, swelling and pain will resolve within 2-4 months.