Achilles Tendonitis Treatments and Medications

Staying active can be challenging even in the best of times. Adding an ankle or foot injury to the mix effectively halts exercise and activity. Some injuries are no more than temporary nuisances, but others, such as Achilles tendonitis, might take months to recover. The good news is that the Achilles tendon will heal. Learn more about the condition and treatment of Achilles tendonitis below.

What is Achilles tendonitis?

Achilles tendonitis (or Achilles tendinopathy) 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.

The Achilles tendon connects the two major calf muscles of the leg to the back of the heel bone, or calcaneus. One of these muscles, the gastrocnemius, flexes the knee, pivoting the calf to the back. Both muscles flex the heel downwards. These two actions, pulling the calf back and pushing the foot down, are critical to walking, running, and jumping. The Achilles tendon takes a lot of mechanical strain all day long, particularly in people with active lifestyles. For this reason, it is the strongest and largest tendon in the body.

The Achilles tendon is made of tough, fibrous tissues that both absorb the stress of leg movements and store energy like a spring. When walking or running, the Achilles tendon compresses whenever the foot strikes the ground. When the foot leaves the ground, the Achilles tendon quickly releases that compressed energy, giving the entire body a push.

Healthcare providers distinguish between Achilles tendon pathologies as Achilles tendonitis—inflammation of the Achilles tendon—or Achilles tendon injuries, such as Achilles tendinosis and Achilles tendon rupture.

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 does 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. Achilles tendon rupture happens suddenly and is often the result of an injury caused by the sudden or explosive movement of the heel, such as pivoting hard on one foot during a tennis or basketball game.

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 Sports 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 fluoroquinolones

• 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 doctor will test for localized tendon pain by gently squeezing areas of the tendon with the foot in different positions. The doctor may also squeeze the calf muscle to test for tendon rupture. The range of heel motion will be tested and the doctor may want to observe gait.

An X-ray, ultrasound, MRI (magnetic resonance imaging), or CT scan 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 and exercise. Orthotics can help maintain proper ankle alignment, and over-the-counter medications can help control pain and swelling.

Conservative therapies

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

Exercise

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. They 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 doctor may inject a corticosteroid to provide rapid symptom relief.

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 will try extracorporeal shockwave therapy (ESWT) to ease pain and help restore the tendon’s functionality. ESWT sends a high-energy sound wave at the tendon and may work by killing nerves in the tendon.

Surgery

Surgery is offered for the 10-30% of cases that do not improve after six months. An orthopedic surgeon will remove the damaged part of the tendon and stitch the tendon together. The success rate is 70%, but the surgery often involves complications.

Achilles tendonitis medications

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. Over-the-counter oral or topical NSAIDs, such as ibuprofen, naproxen, aspirin, or topical trolamine, ease swelling and help restore most function. More severe pain can be treated with more powerful prescription NSAIDs. Patients with bleeding or gut problems will be prescribed celecoxib, an NSAID that does not interfere with blood clotting. Those patients with heart disease and kidney damage, should use NSAIDs cautiously after discussing with their physician. Acetaminophen, an over-the-counter pain reliever, can be used by people who are unable to take NSAIDs.

Corticosteroids

Steroid injections are reserved for debilitating pain or serious loss of function due to Achilles tendonitis. The doctor will inject a small dose of methylprednisolone, cortisone, or other corticosteroid along with an anesthetic such as bupivacaine directly into the affected area of the tendon. Pain and symptom relief are usually immediate and can last for up to six weeks.

What is the best medication for Achilles tendonitis?

Achilles tendonitis medications relieve pain and swelling. If a patient can achieve sufficient pain relief from activity modification, icing, and support devices, then the best medication is no medication at all. If not, the most commonly used medications for Achilles tendonitis pain relief are over-the-counter NSAIDs, but there is no “best” medication for Achilles tendonitis.

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Best medications for Achilles tendonitis