Achilles Tendonitis Treatment Guidelines

What is Achilles tendonitis?

Achilles tendonitis is an overuse injury that causes inflammation, irritation, or degeneration of the Achilles tendon, the band of tissue connecting the calf muscles to the heel bone. It is common among athletes and individuals who engage in repetitive or intense physical activities.

Types of Achilles tendonitis

There are two main types of Achilles tendonitis:

• Non-insertional Achilles tendonitis: This type affects the middle portion of the tendon and is more commonly seen in younger, active individuals, particularly those who engage in high-impact sports.
• Insertional Achilles tendonitis: This form involves the lower part of the tendon, where it attaches to the heel bone. It is often seen in less active individuals or those who experience chronic irritation, often exacerbated by tight footwear or improper biomechanics.

Causes and symptoms

Achilles tendonitis is often caused by repetitive strain from activities like running, jumping or sudden increases in exercise intensity. Poor footwear, tight calf muscles, and improper training techniques can also contribute.

Common symptoms include pain or stiffness along the Achilles tendon, especially in the morning or after activity, swelling, tenderness, and difficulty walking or running. Early treatment is crucial to prevent progression to tendon rupture.

Achilles Tendonitis Treatment Guidelines

Our comprehensive treatment guidelines provide evidence-based strategies to alleviate symptoms and restore function in Achilles tendonitis. Here is a brief overview of the available treatment options:

Conservative treatment of Achilles tendinopathy

Conservative approaches are the first-line treatment for AT and emphasize reducing pain, improving tendon function, and addressing biomechanical factors contributing to tendon overload.

• Activity modification: Patients should avoid high-impact activities like running and jumping but remain active within tolerable pain limits. Low-impact exercises like swimming or cycling maintain fitness while preventing tendon deconditioning. Structured rehabilitation programs emphasizing gradual loading support tendon remodeling and recovery.
• Therapeutic exercise: Eccentric loading exercises like the Alfredson protocol are the gold standard for managing non-insertional AT. These exercises promote collagen remodeling and improve tensile strength, with heavy slow resistance training offering a viable alternative for some patients.
• Physical therapy modalities: Adjunct therapies like extracorporeal shockwave therapy (ESWT) and ultrasound therapy may relieve pain and stimulate healing. ESWT is particularly beneficial when combined with eccentric exercises, though its application requires careful protocol adherence for optimal outcomes.

Pharmacological interventions

Pharmacological treatments address pain management and symptom control to support effective rehabilitation strategies.

• NSAIDs and cryotherapy: NSAIDs can provide short-term pain relief, though their role in tendinopathy remains limited. Cryotherapy offers temporary analgesia by reducing tendon metabolism and blood flow but is not considered a definitive treatment.
• Nitric oxide therapy: Topical nitric oxide administration has shown mixed results in improving AT symptoms. While early studies were promising, recent evidence suggests no significant long-term benefits, highlighting the need for further research.

Surgical intervention

Surgery is reserved for patients who do not respond to six months of conservative management. Options range from traditional open surgery to minimally invasive techniques, such as percutaneous longitudinal tenotomies and endoscopic debridement, which reduce recovery time and complication rates.

Open surgery

Open surgery is typically used in severe or complex cases, such as those involving extensive degenerative tissue or significant structural damage to the tendon. This procedure involves an incision directly accessing the Achilles tendon, removing damaged or necrotic tissue, and repairing or reconstructing the tendon as needed.

Minimally invasive techniques

Minimally invasive procedures are increasingly preferred for reduced recovery and complication rates. Techniques such as percutaneous longitudinal tenotomies involve small incisions to remove damaged tissue and stimulate healing. At the same time, endoscopic debridement allows surgeons to remove degenerative areas precisely using a camera and specialized instruments.

How to use our Achilles Tendonitis Treatment Guidelines handout

Our treatment guidelines handout for Achilles tendonitis provides a clear, structured approach to managing this common condition. Follow these steps to make the most of the handout in your clinical practice:

Step 1: Download the template

Access the Achilles Tendonitis Treatment Guidelines handout by clicking "Use Template" for an editable version via the Carepatron app. For a ready-to-print option, choose "Download PDF."

Step 2: Use in clinical practice

Refer to the handout as a comprehensive guide for evaluating and managing patients with Achilles tendonitis. It outlines evidence-based treatments, including conservative approaches like eccentric loading exercises, pharmacological interventions such as NSAIDs, and surgical options, including minimally invasive procedures and open surgery.

Step 3: Review guidelines with your patient

Use the handout to explain the condition during the appointment and discuss the recommended treatment options with your patient. Walk through the guidelines to ensure they understand their care plan and address any questions. After the appointment, provide the handout as a take-home resource for later reference, helping patients stay informed and engaged with their treatment.

Step 4: Keep for future reference

Store a copy of the handout in the patient’s file. This ensures continuity of care, facilitates interdisciplinary collaboration among healthcare providers, and serves as a quick reference during follow-up visits.

Benefits of using our treatment guidelines

Here are some of the benefits of using our handout for your practice:

Structured approach to care

The guidelines offer a comprehensive overview of the evidence-based treatment and management options for Achilles tendonitis, ensuring a standardized and reliable approach to patient care.

Improved patient understanding

By reviewing the guidelines with patients during appointments, healthcare providers can effectively communicate the condition, available treatment options, and care plans. This fosters better patient engagement and confidence in their treatment.

Flexibility for customization

The editable template allows healthcare providers to tailor the guidelines to individual patient needs, ensuring personalized care that addresses specific symptoms and treatment goals.

Streamlined practice workflow

Having a readily available, comprehensive resource reduces time spent on explanations and improves efficiency in clinical practice, allowing more focus on patient care.