Top Tips For Achilles Tendon Treatment

The following is excerpted from my office handout for patients who present with Achilles tendinosis and partial tears. This handout forms a possible outlines of treatments and tests when the tendon itself is damaged in some way or when diagnosed Achilles tendonitis does not improve.

Achilles tendinosis implies that the tendon is damaged more than inflamed (like in Achilles Tendinitis conditions). Partial tears are a part of this condition that I find drives everyone, doctor and patient, bananas. There are so many degrees of tendon disease. Magnetic resonance imaging (MRI), if possible, is frequently necessary to document what is going on. The top treatments/general rules for Achilles tendinosis and partial tears in my practice are:

1.      When the tendon is thicker than normal, or swelling will not go away, consider an MRI to check if a partial tear is present.

2.      With tendinosis, some form of immobilization is important to create a pain-free environment (tape, below knee CAM walker, ankle-foot orthosis (AFO), high-top boot).

3.      With a partial tear of the Achilles tendon, three months of a CAM walker/removable boot is crucial (when a pain-free situation does not occur with activity modification).

4.       With tendinosis, physical therapy can occur at the same time as the immobilization, but with a partial tear, physical therapy normally starts after the three months of immobilization.

5.        Both of these conditions may require surgery, so a surgical consult can take place to evaluate options (so that the patient is aware of their upcoming choices).   

6.       As the tendon gets less sore with icing for five to 10 minutes, three times per day, I gradually begin to strengthen. I love two positional heel raises (also called heel lifts or calf raises), up to 100 each evening, as long as there is no pain, gradually leaning to the injured side and gradually progressing to 25 one-sided calf raises.

7.      Maintaining pain-free status, I encourage Achilles tendon stretching, both straight and bent knee, three to five times a day, for 30 seconds per stretch.

8.        Platelet-rich plasma (PRP) injection, in my opinion, is a rising star in medicine to consider, in an attempt to hopefully avoid surgery.

9.       Like in all cases of Achilles pain, heel lifts and custom orthotic devices are part of standard treatment for a year following the “return to activity” phase.

Complete Achilles tears, versus tendinosis or partial tears, are in some ways a much easier decision algorithm. Once one makes the diagnosis, one either pursues surgical intervention or a prolonged casting regimen. I personally find Achilles tendinosis and partial tears are often undertreated. I find that keeping patients with these injuries at a zero-to-two pain scale level throughout all activities often necessitates immobilization and MRI to document the injury clearly.

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com. 

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.