Treating Achilles tendinitis: Know your options.
Achilles tendinitis is a deterioration of the Achilles tendon, the band of tissue that links your lower leg muscles to your heel bone. This long-term accumulation of microscopic injuries to the Achilles tendon, which has not had the chance to heal properly, can actually be more accurately referred to as Achilles tendinosis.
Though most cases of Achilles tendinosis can be treated with basic at-home care under your doctor’s supervision, more serious cases of the condition can lead to tendon tears (ruptures) which may require surgery. Depending on the severity of your diagnosis (*link to Diagnosis article 3*), there are a variety of corresponding treatments out there to get you back into shape. It’s just important to know your options and decide together with your doctor which alternative is best for your own treatment.
Treatments and drugs
Achilles tendinitis is usually treated with relatively simple interventions, but successful treatment requires patience and careful adherence to treatment guidelines. Your doctor is likely to recommend a combination of methods to overcome Achilles tendinitis:
- Self-care strategies
- Pain medications
- Stretching and exercises
You are your most significant ally regarding your own Achilles tendinitis treatment. Fundamental self-care, encompassed by the acronym R.I.C.E., includes the following steps:
- Rest – Rest is essential for tissue healing. Depending on the severity of your symptoms, resting may mean not exercising for several days; reducing the duration and intensity of your routine; or switching to an activity that doesn’t strain the Achilles tendon, such as swimming. Though it may seem frustrating at first, patience pays off. You may need to wear a walking boot and use crutches if you have significant pain when putting weight on your foot. Your doctor can advise you on what type of rest is appropriate for you.
- Ice – To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain.
- Compression – Wraps or compressive elastic bandages may help reduce the swelling, as well as movement of the tendon.
- Elevation – Raise the affected foot above the level of your heart to further reduce swelling. It’s recommended to sleep with this ankle elevated at night.
Your doctor is also likely to recommend a prescription-strength or over-the-counter non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) to reduce inflammation and relieve pain resulting from Achilles tendinitis. Tylenol™ often works great for this problem.
**Long-term use of NSAIDs can cause stomach pain, stomach bleeding, ulcers and other side effects. Talk to your doctor about how long you should take your medication and how he or she will monitor you for side effects.
Stretching and exercise
Appropriate stretching and exercise can promote healing and prevent recurring problems. Your doctor can demonstrate the proper technique or refer you to a physical therapist or specialist in sports medicine. These techniques include:
- Stretching with knees straight – Lean against a wall with your knees straight and heels on the floor to stretch the upper portion of calf muscles.
- Stretching with knees bent – Place the foot forward and flex the knee and ankle with the heel flat on the floor to stretch the lower portion of calf muscles.
- Exercising calf muscles – Toe raises or the use of a calf-strengthening machine can help make the tendon stronger and treat Achilles tendon problems. A special type of strengthening called “eccentric” strengthening has been shown to be particularly effective in treating chronic tendon problems. An example of this type of exercise to strengthen the calf muscle is slowly descending to the ground after rising on your toes.
There are also more advanced forms of treatment that may better suit your individual case of Achilles tendinitis. Depending on your diagnosis, additional treatments may include the following:
- Orthotic devices protect or change the position of the foot and ankle in order to support healing. A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that decreases the amount of force exerted on the tendon.
- Platelet rich plasma (PRP) injection is a relatively new treatment under investigation for treating chronic, non-healing degeneration of the Achilles tendon and other chronic tendon problems. This treatment involves injecting your own blood plasma, which contains factors that promote healing, at the site of the inflamed tendon.
- Surgery to repair damaged tissue and improve function of the tendon is considered only when several months of more conservative treatments do not work or if ongoing inflammation results in partial or complete rupture of the tendon.
When it comes to Achilles tendinitis intervention, education is the key. As they say, knowledge is power. By understanding the variety of treatment options, it’s much easier to facilitate an open discussion with your doctor or specialist – and you know more of what to expect!
Image courtesy of samarttiw / FreeDigitalPhotos.net
Dr. Meredith Warner is a board certified, Fellowship Trained Foot and Ankle, Orthopedic surgeon practicing in Baton Rouge, Louisiana. Dr. Warner is committed to offering her patients an accurate diagnosis along with a comprehensive treatment plan in order to get them back to a pain free life. Dr. Meredith Warner specializes in the treatment of orthopedic issues, providing operative and non-operative treatment plans of orthopedic problems, including musculoskeletal pain such as chronic back, neck and foot pain, reconstructive surgery of the foot and ankle, arthritis, diabetic, hammer toe, bunion, wound care, work injuries, fitness and nutrition and osteoporosis issues.