Achilles Tendinitis: Treatment Options

Achilles Tendinitis: Treatment Options

With proper treatment in a timely fashion, Achilles tendinitis symptoms can go away, returning patients to their normal activity. However, since they had tendinitis in the first place, it may come back again if the patient does not keep their foot and ankle healthy. If Achilles tendinitis is left untreated and the patient continues physical activity despite the pain, it is possible that the tendon will rupture due to increased inflammation and weakness of the tissue. This problem is more significant and would require more extensive treatments.

When a patient gets diagnosed with Achilles tendinitis, the healthcare provider will usually recommend starting with nonoperative treatment. There are several ways to treat Achilles tendinitis without surgery. Physical therapy, ice, and avoiding aggravating activities are important. Some healthcare providers will recommend non-narcotic medications like anti-inflammatories, as well as shoe inserts or heel lifts. If certain shoes make the pain worse, not wearing them will help. There are also different types of injections the healthcare provider may recommend, which can decrease symptoms as well.

Surgery is typically avoided in someone with mid-substance achilles tendonitis, where the pain and inflammation are up in the soft tissue. If a patient has insertional Achilles tendinitis, where the tendon inserts on the heel bone and nonoperative treatment is not helping, a surgeon may recommend having a procedure done to fix it. Many patients with insertional Achilles tendinitis have a haglund's deformity, an extra bump of bone that contributes to the pain. Part of the procedure consists of splitting the Achilles tendon in half and lifting it off the bone to remove this extra bump. After that, the surgeon will use any number of combinations of sutures and anchors, such as the one shown here, to repair the split in the tendon and secure the tendon back down to the bone. In some cases, the surgeon may want to supplement or augment the repair with another tendon in the foot. There is a tendon attached to the big toe that can be moved to the heel to help with strength of the Achilles repair.

After surgery, the patient will wear a splint for the first 2 weeks and use crutches to allow the tendon to start to heal. It is important to keep the leg elevated to help prevent swelling. After about 2 weeks, the splint will get switched out for a walking boot and the surgeon will determine if the patient can put weight on it. Next, physical therapy will begin for stretching and strengthening. Following instructions is important to protect the repair while it heals. Typically, patients can expect to return to normal activity within 6 months of the surgery.