Achilles Tendinitis (Tendonitis)

Overview

Achilles tendinitis is an overuse injury of the Achilles tendon, which connects the calf muscles to the heel bone. It presents with pain, stiffness, and swelling at the back of the ankle, often worse with activity.

Risk factors include repetitive stress (running, jumping), tight calf muscles, poor footwear, sudden increase in training, obesity, and fluoroquinolone antibiotics.

Two types:

• Non-insertional: fibers in the middle tendon degenerate, common in younger athletes.

• Insertional: pain at tendon’s attachment to the heel, more common in older individuals.

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Treatment Options

1. Conservative Management (First-Line)

• Rest and activity modification: avoid high-impact activities; switch to swimming/cycling temporarily.

• Ice application: 15–20 min every 4–6 hours during acute phase.

• Footwear modification: cushioned shoes, heel lifts, orthotics.

• Physical therapy:

  • Eccentric calf muscle strengthening exercises (most evidence-based).

  • Stretching exercises for calf and Achilles tendon.

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2. Pharmacological Therapy (Symptomatic Relief)

• NSAIDs (for pain and inflammation):

  • Ibuprofen: 400–600 mg PO every 8 hours as needed.

  • Naproxen: 250–500 mg PO BID.

• Topical NSAIDs: diclofenac 1% gel applied 3–4 times daily.

• Acetaminophen: 500–1000 mg PO every 6–8 hours (max 4 g/day) if NSAIDs contraindicated.

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3. Advanced/Adjunctive Therapies

• Corticosteroid injections: not recommended directly into tendon (risk of rupture); may be used around tendon sheath if severe inflammation.

• Platelet-rich plasma (PRP) injections: investigational but sometimes used to promote healing.

• Extracorporeal shockwave therapy (ESWT): can be considered for chronic cases.

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4. Surgical Management

• Reserved for refractory cases (>6 months failed conservative therapy).

• Debridement and repair of damaged tendon tissue.

• Tendon transfer or augmentation in severe degenerative cases.

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Supportive Care

• Weight reduction in overweight patients to reduce tendon stress.

• Gradual return to activity (avoid sudden increases in training).

• Heel lifts in both shoes to reduce tendon strain during recovery.

• Preventive measures: regular stretching, proper footwear, and progressive training schedules.

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Key Notes

• Most cases improve with 6–12 weeks of conservative therapy.

• Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin) increase risk of tendon rupture and should be avoided in high-risk patients.

• Untreated tendinitis can progress to tendinosis or tendon rupture, requiring surgical repair.