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How is Achilles tendonitis treated?

Jane Milliff
Physical Therapy Specialist

Achilles tendonitis is very treatable but takes patience because tendon injuries take six to eight weeks to heal once all the aggravators are removed. You may not have to stop running but activity modification is very important, as is a slow and progressive return to your prior volume of running. If the pain does not decrease significantly in two weeks, see a professional. Following is a list of treatments you can try at home:

  • Only stretch your calves if you can do so with no tendon pain.
  • When stretching, keep your knee and foot straight and your arch high.
  • Ice when it is inflamed and heat during the later phases of healing.
  • Massage lower leg muscles and gently massage for the tendon.
  • Replace worn shoes and stick to running on flat and soft terrain.
  • Cross train including cycling, swimming and walking.
  • Strengthening your ankles with resistance bands.
  • Wear night splints if tolerated to improve calf flexibility (Strassburg Sock).

If these measures don't resolve your problem, you should consider professional help. Some helpful measures include:

  • Trigger point dry needling for your calves and the tendon
  • Kinesiotaping
  • Neural dynamics evaluation and treatment of the lower extremity
  • Active release technique

Once you are feeling better, a slow and gradual return to your sport is critical.

Most answers here and information on the web focus on treatments to decrease the inflammation/pain (medications like Advil or Aleve, ice, electrical stim, rest from aggravating activities, etc.), stretching the inflamed tissue, and strengthening the muscles and tendon. While these are often effective and are typical first-line treatments for Achilles tendonitis, some patients find their tendonitis very difficult to treat and long-lasting. Usually this means the tendon has become stiff, "scarred" or fibrotic and not very functional. We refer to this as tendonosis. The treatment for tendonosis is often very different, involving aggressive therapy, needling/injections, medicated patches or even rarely surgery. While effective in almost all cases, these treatments need to be administered by a trained and experienced physician such as a sports medicine specialist.

Yusuf Boyd, NASM Elite Trainer
Athletic Training Specialist

Treatment of Achilles tendonitis involves rest, ice, use of a heel cup and/or taping to prevent full dorsiflexion and gentle stretching. Depending on the severity of the injury, immobilization may be prescribed. Always consult with your physician if an injury is suspected.

Dr. James P. Ioli, DPM
Podiatrist (Foot Specialist)

Treatment of both Achilles tendinitis and Achilles tendinosis involves a regimen known as RICE—rest, ice, compression and elevation—and nonprescription pain relievers. If the tendon is swollen and warm, you may benefit from a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen or naproxen for three to four weeks in order to reduce inflammation.

Once the pain and swelling are gone, try to stretch the tendon gently to strengthen it. Stretching exercises for the bottom of your feet can help; the plantar fascia (the ligament-like structure that connects the heel to the ball of the foot) works with the Achilles tendon, lever-and-pulley style, to move the foot. Your foot care specialist may also prescribe heel lifts or Achilles heel cushions to provide heel support and take pressure off the Achilles tendons. If the pain and swelling persist, see a foot care specialist, who may prescribe physical therapy to alleviate your symptoms. In addition, a night splint can help by keeping the Achilles tendon in a stretched position while you sleep. Don't expect immediate results. Typically, these conditions heal within 6 to 12 months. If the tendon has completely ruptured or torn away from the bone, you may need surgery.

Treatment for an Achilles tendon that has completely ruptured may include surgery requiring a small incision to reattach the tendon, followed by splinting, or splinting alone.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.