Achilles Tendonitis Treatments and Medications

Achilles tendonitis is an inflammation of the Achilles tendon due to repetitive overuse of the tendon or mechanical stress. The inflammation causes pain and limits the use of the tendon and attached muscles. Achilles tendinosis is a chronic degeneration of the Achilles tendon fibers due to small tears in the tendon tissues. The tendon itself becomes thicker and stiffer but may not swell. Achilles tendon rupture is a severe and sometimes debilitating injury in which the Achilles tendon tears either partially or all the way through. Thankfully, there are various treatment options for Achilles tendonitis.

How is Achilles tendonitis diagnosed?

Achilles tendonitis is diagnosed primarily through a physical examination of the injury and medical history. Imaging tests may be necessary to assess the injury and rule out other injuries.

In the first visit, an orthopedist or primary care physician will try to determine the nature of the injury. Be prepared to answer the following questions:

• When did the pain start?

• What part of the Achilles tendon hurts?

• What activities cause pain in the Achilles tendon?

• When does the pain start, at the beginning of an activity or later?

• Does the pain diminish or worsen during activities?

• Has the Achilles tendon been injured or painful before?

You may be asked to fill out a Victorian Institute of Sport Assessment (VISA-A), a questionnaire that asks detailed questions for active people about Achilles tendon pain.

The medical history will also help identify risk factors for Achilles tendonitis. People most at risk for Achilles tendonitis are athletes (particularly runners), sports participants, and people with active lifestyles or jobs. Other risk factors include:

• Age

• Use of certain types of medications, such as corticosteroids or fluoroquinolone antibiotics

• Metabolic disorders such as diabetes, rheumatoid arthritis, or high cholesterol

• Excess weight

• Improper footwear

• Walking or exercising on hard surfaces

• Inadequate warm-ups and stretching before exercise

In a physical exam, the healthcare professional will look for swelling and tenderness. The provider will test for localized tendon pain by gently squeezing areas of the tendon with the foot in different positions. They may also squeeze the calf muscle to test for tendon rupture. The range of heel motion will be tested, and the provider may want to observe gait. 

An X-ray, ultrasound, or MRI (magnetic resonance imaging) may be used to rule out other conditions, such as Achilles tendinosis or Achilles tendon rupture.

Achilles tendonitis treatment options

Tendons heal very slowly, particularly the Achilles tendon. Treatment may last three to six months before the tendon returns to full functionality. Achilles tendonitis treatment aims to reduce the risk of further injury, manage the pain, and return the tendon to normal function. The most common treatment to achieve these goals is to rest, exercise, and undergo physical therapy. Orthotics can help maintain proper ankle alignment, and prescription or over-the-counter medications can help control pain and swelling.

Conservative therapies

Achilles tendonitis will typically improve on its own with activity reduction (called relative rest), footwear changes, calf massage, icing, elevation, and compression.

Exercise/Physical therapy

The gold standard for Achilles tendon treatment is a daily regimen of eccentric exercises along with other conservative therapies. Eccentric exercises and stretching gradually increase the ability of the tendon to handle loads. Your healthcare provider may refer you to a physical therapist who can recommend exercises that are appropriate for you. Common exercises include standing on tiptoes, heel lifts, heel drops, and stretches, all while supporting the body’s weight against a wall. An eccentric exercise program typically takes three to six months to complete.

Medications

The pain and swelling of Achilles tendonitis can be relieved by over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) and other pain relievers, such as acetaminophen. For more debilitating tendon pain, a healthcare provider may recommend prescription-strength NSAIDs.

Support

Support devices can significantly help the tendon healing process. A podiatrist can help design custom orthotics that can significantly reduce Achilles tendon pain by keeping the Achilles tendon from twisting when walking or standing. Ankle braces support proper foot and ankle alignment when walking, sitting, or standing. Support socks not only help maintain ankle alignment but also stimulate blood flow to the tendon. Finally, night splints immobilize the ankle during sleep.

Extracorporeal shockwave therapy

If conservative treatment doesn’t work, orthopedic specialists may try extracorporeal shockwave therapy (ESWT) to ease pain and help restore the tendon’s functionality. ESWT sends a high-energy sound wave to the tendon to promote healing, but more research is needed on its effectiveness.

Surgery

Surgery may be needed for patients who do not see improvement after six months. The type of surgery depends on the location of the tendonitis and the severity of damage. An orthopedic surgeon can evaluate the need for surgery.   

Types of Achilles tendonitis medication

Medications are only used to reduce pain and swelling caused by Achilles tendonitis. No medication cures Achilles tendonitis or speeds up the healing process.

NSAIDs (Non-steroidal anti-inflammatory drugs)

NSAIDs reduce the swelling and pain in the Achilles tendon. While some patients may find over-the-counter NSAIDs to relieve symptoms (see below), others may need stronger NSAIDs. In these cases, healthcare providers may prescribe NSAIDs such as meloxicam, celecoxib, or prescription-strength naproxen or ibuprofen. 

Over-the-counter Achilles tendonitis medicine

Over-the-counter (OTC) NSAIDs may help with pain and swelling. Oral NSAIDs that are available over the counter include naproxen, ibuprofen, and aspirin. Topical OTC NSAIDs, such as diclofenac, are another option for pain and swelling. People who cannot take NSAIDs may prefer Tylenol (acetaminophen), which helps with pain but not inflammation. Check with a healthcare provider before using OTC medicine.

Achilles tendonitis medications relieve pain and swelling. If a patient can achieve sufficient pain relief from activity modification, icing, and support devices, then medication may not be needed. If more pain relief is required, the most commonly used medications for Achilles tendonitis pain relief are over-the-counter or prescription NSAIDs.

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Best medications for Achilles tendonitis