Treating a Painful Achilles Tendon

The recommended treatments attempt to control inflammation if it is present, minimize stress on the Achilles tendon, and promote healing.

Initial treatments for Achilles tendonitis, tendinosis and other tendon problems include:

• Rest. Depending on the severity of the injury, the doctor may recommend full or partial rest. If partial rest is assigned, athletes may be advised to modify their training schedules or training-intensity levels.
• Change playing surface. Some doctors advise athletes to use softer playing surfaces. For example, most experts believe jogging on a synthetic soft track instead of concrete sidewalks will put less stress on an Achilles tendon and other joint structures.

• Change of footwear. Everyone, particularly athletes, is advised to pick shoes that offer both support and comfort.
• Ice. Ice baths, ice massages, or cold compresses may be recommended to reduce pain and inflammation in the Achilles tendon. Patients may use ice treatments for 10 to 20 minutes following activity.
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (e.g. Motrin, Advil), naproxen (e.g. Aleve, Naprosyn), and cox-2 inhibitors (e.g. Celebrex).

• Orthotic devices. Achilles straps, heel lifts, and other orthotic devices can be worn during the day. Orthotics may minimize stress-load on the tendon as well as ensure proper shoe fit and wear.
• Night splints. Worn while sleeping, night splints provide a prolonged stretch to the Achilles tendon.
• Bracing or casting. A temporary brace or walking cast (a “boot”) can keep the ankle from moving, giving the Achilles tendon time to heal.
• Transdermal nitroglycerin patches. Daily application of transdermal nitroglycerin patches has been reported to be helpful in some more severe cases of Achilles tendinopathy.¹Tsai WC, Tang FT, Hsu CC, et al. Ibuprofen inhibition of tendon cell proliferation and upregulation of the cyclin kinase inhibitor. J Orthopedic Resear. 2004. 22(3): 586–591. doi: 10.1016/j.orthres.2003.10.014. These patches may be sold under the names Minitran, Nitrek, Nitro TD Patch-A, and Nitro-Dur.
• Physical therapy. A licensed physical therapist may use one or more of the following treatments, each of which attempt to reduce pain, improve the body’s ability to heal, or both.

• Stretching and eccentric strengthening exercises improve ankle stability.
• Cross-friction massage (deep pressure applied against the tissue grain) stimulates blood flow and improves mobility.
• Therapeutic ultrasound stimulates the Achilles tendon and surrounding muscles with high-frequency sound waves.
• Iontophoresis, uses a mild electrical current to administer an anti-inflammatory medicine through healthy skin and into the Achilles tendon. (This treatment may be recommended to people who can't tolerate injections or want to avoid injections.)
• Cold Level Laser Therapy, also called low level laser therapy, uses specific wavelengths of light to accelerate the tendon healing process.²Bjordal JM, Lopes-Martins RA, Joensen J, et al. A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskeletal Disorders. 2008;9:75. doi:10.1186/1471-2474-9-75.
• Extracorporeal shockwave therapy (ESWT) is a non-invasive procedure that uses high-energy shockwave impulses to help facilitate the healing process in damaged tendon tissue. There is growing evidence of its effectiveness but it is primarily utilized when all other conservative treatment options have failed.³Uquillas CA, Guss MS, Ryan DJ, Jazrawi LM, Strauss EJ. Everything Achilles: Knowledge Update and Current Concepts in Management: AAOS Exhibit Selection. J Bone Joint Surg Am. 2015 Jul 15;97(14):1187-95. doi: 10.2106/JBJS.O.00002. Review. PubMed PMID: 26178893. Low-energy ESWT can be performed by a therapist, but high energy ESWT can cause pain and is performed as an outpatient procedure using local or regional anesthesia.

While heat therapy is frequently recommended for treating other types of musculoskeletal injuries, using heat to treat of Achilles pain is usually discouraged.