The Foot and Ankle Clinic

Achilles Tendonitis treatments

What is achilles tendonitis? | What does achilles tendonitis look like? | Insertional problems of the achilles | Symptoms of achilles tendonitis | Causes of achilles tendonitis | Treatments for achilles tendonitis | Physiotherapy for achilles tendonitis | Orthotic for achilles tendonitis | How soon should non-operative treatment of achilles tendonitis improve symptoms? | Injecting achilles tendonitis | What if achilles tendonitis fails to settle despite injection? | The surgical treatment of achilles tendonosis | What is the rationale behind the operations? | Achilles paratenon stripping and tendon incision - operative stills | Post operative course following achilles tendonitis surgical treatment | Complications following debridement of achilles tendonitis/tendonosis | Operative gallery for flexor hallucis longus tendon transfer | Post-operative course after flexor hallucis longus tendon transfer | Complications following a flexor hallucis longus transfer | What is a Hagglunds deformity? | What Is insertional tendonosis of the achilles? | Treatment for Hagglunds deformity/or insertional achilles tendonosis | Non-operative treatment of Hagglunds deformity, achilles tendonosis | Operative management of Hagglunds deformity and insertional achilles tendonosis

Treatments for Achilles Tendonitis?

Both operative and non-operative managements are available for Achilles tendonitis. Generally, one would be advised to try non-operative management first though dependent upon length and severity of symptoms this is open to discussion of course. There are two, seemingly diametrically opposed, ways of managing Achilles tendonitis non-operatively. On the one hand one may go down the route of splinting, immobilisation and resting of the Achilles tendonitis. On the other hand one may go down the route of physiotherapy, supervised massage, stretches and strengthening type exercises for Achilles tendonitis. Both routes seem to work with equal likelihood. It is not possible to know who would benefit from one route and who would benefit from another.

Physiotherapy for Achilles Tendonitis

In the acute phases ultrasound, restriction of activity and rest for the Achilles tendon are likely to be advised. Later deep friction massage of the tendon will be started and exercises to stretch the Achilles tendon will be taught. Non-steroidal anti-inflammatory tablets such as Brufen may be useful if these are not contra-indicated.

Orthotic for Achilles Tendonitis

The minimum is to try a heel raise. This is a wedge of material which raises the heel relatively to the foot, thus removing some of the tension from the Achilles tendon.

You may feel easier wearing high heels, though for men this probably should be limited just to Friday or Saturday nights(and when your wife is out). An alternative form of treatment of Achilles tendonitis is to wear an Achilles Aircast walking boot. This should be used for all weight bearing activity and the back part of the boot should be rested in bed at night. Short periods of driving during treatment for Achilles tendonitis are possible. Full weight bearing in the Aircast boot is also possible during treatment for Achilles tendonitis.

How Soon Should Non-Operative Treatment of Achilles Tendonitis Improve Symptoms?

Some symptoms from the Achilles tendon should improve soon, perhaps within days or weeks. Lasting improvement however takes longer and it may be up to 3-6 months before significant inroads are made into the symptoms. If the symptoms of Achilles tendonitis have failed to improve much by this stage, then they are unlikely to do so with further conservative treatment. All told, success rate in the region of 50-75% can be expected with conservative management of the Achilles tendonitis.

Injecting Achilles Tendonitis

If non-operative treatments have failed then prior to proceeding to more invasive treatments it is important to be sure about the exact nature of the underlying condition of the Achilles tendon. In particular, it is important to distinguish between Achilles tendonitis and Achilles tendonosis (where degenerative change of the underlying tendon substance exists). This differentiation between these conditions can be made either with an MRI scan or ultrasound of the Achilles tendon.

If an ultrasound scan is used to assess the Achilles tendon then this provides the opportunity of infiltrating some steroid and local anaesthetic around the tendon sheath accurately under “direct visualisation” of the tendon . This can be done at the same sitting but generally will only be used if Achilles tendonitis is present and not if there is any evidence of Achilles tendonosis .In the case of the latter condition there is the risk of tendon rupture by infiltrating steroid around it . Injection of steroid and local anaesthetic into the Achilles paratenon for Achilles tendonitis should be followed by a period of reduced activity.

What If Achilles Tendonitis Fails to Settle Despite Injection?

The surgical treatment of Achilles tendonitis involves a direct incision over the inner aspect of the back part of the tendon. The surrounding paratenon (sheath around the tendon) is stripped away from the tendon. In isolation this is an unusual procedure to need to perform. It is more usual that the paratenon is stripped away from the tendon as part of the treatment of Achilles tendonosis.

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