Effective Treatment Options for Chronic Achilles Tendonitis

Although physical activity is a great way to strengthen the muscles and maintain fitness, putting too much strain on the same muscles over time can actually weaken them. When this happens to the tendons, the thick bands of tissue that connect the bones to the muscles, it is called tendonitis, or tendinopathy. The Achilles tendon, found on the back of the heel bone and linking to the calf muscle, is the body’s strongest tendon and is one of the most common tendinopathies seen by podiatrists and sports medicine doctors. The condition, called Achilles tendonitis, can severely impact athletic performance and cause chronic pain that disrupts daily life.

While Achilles tendonitis is most commonly found in runners, it has even been seen in those who have a sedentary lifestyle, suggesting there are other risk factors that have not yet been identified. Known risk factors, other than being a runner, include older age, male sex, being overweight, or having a genetic history of chronic Achilles tendonitis. However, this condition is so prevalent among runners that research shows it occurs in more than half of former runners, and in as many as 9% of current runners. If you are a runner who experiences persistent pain and inflammation in one or both ankles after running, you could have chronic Achilles tendinitis.

To evaluate the extent of the condition affecting your heel(s), your doctor will likely suggest diagnostic imaging, a physical examination, and taking a complete medical history. This helps your doctor properly diagnose whether you have chronic Achilles tendonitis or some other condition. Usually, your doctor will recommend nonsurgical therapies as the first-line treatment, unless your Achilles tendonitis is particularly severe.

Nonsurgical Versus Surgical Treatments for Achilles Tendonitis

Conservative, nonsurgical treatments for Achilles tendonitis include rest, activity modification, over-the-counter painkillers, simple heel lifts, or stretches performed during physical therapy. Your doctor may also recommend correction of any foot and ankle malalignments by providing you a custom-fit boot on the affected leg. This customized foot support is a boot made by your physician using computerized orthotic scanning, called prescription orthotics.

Usually, after the failure of the above-mentioned nonsurgical treatments, you doctor may recommend platelet-rich plasma (PRP) therapy injections. Platelets are a blood component that can aid in clotting and healing. By extracting PRP from your blood and injecting it into the tendon, it can stimulate healing while also reducing swelling and inflammation. Many patients experience significant symptom relief from PRP therapy, but clinical improvement is significantly slower in patients whose pre-treatment symptoms were more severe and had a longer history of heel pain. It may also take a few months to experience the full healing benefits of PRP injections, and many athletes are reluctant to take such a gamble.

Chronic Achilles tendonitis causes consistent pain and doesn’t always respond well to nonsurgical treatments. In fact, sparse evidence suggests the effectiveness of nonsurgical treatments in those whose Achilles tendonitis is so chronic that it eventually rubs on the bone, causing a posterior calcaneal heel spur. In one study, nearly one-third of patients who presented with symptoms were recommended surgical treatment after 6 months. Overall, as many as 25% of those who see a doctor for chronic Achilles tendonitis end up having surgical treatment for adequate symptoms relief.

Surgical treatment is usually the preferred method if your Achilles tendon has led to the development of a heel bone spur. The surgical treatment is performed under general anesthesia, and the procedure involves removing the bony bump and potentially detaching the tendon to re-anchor it to provide adequate symptoms relief. The specific surgery for any given patient is tailored to their needs, and depends upon the location and extent of the tendonitis.