Unveiling the Latest Approaches to Achilles Tendonitis Treatment: From Conservative Measures to Innovative Surgeries
Achilles tendonitis, a common foot problem among athletes and non-athletes alike, involves inflammation of the Achilles tendon, which is the largest tendon in the body. This condition can cause significant discomfort, limiting daily activities and affecting quality of life. To manage and treat Achilles tendonitis, there is an array of options that range from conservative methods to innovative surgical procedures. In this article, we explore these treatments and recent advances in managing Achilles tendonitis.
Understanding Achilles Tendonitis
Achilles tendonitis is characterized by pain along the back of your heel. This discomfort is usually more pronounced after running or other high-impact activities. When the Achilles tendon, which connects your calf muscles to your heel bone, is overused or subjected to high stress, it can become inflamed, resulting in Achilles tendonitis.
Conservative Treatment Options
Conservative treatments are usually the first line of defense against Achilles tendonitis. These non-invasive therapies focus on reducing inflammation and promoting healing of the affected tendon. Initial conservative management should consist of nonsteroidal anti-inflammatory drugs (NSAIDs), rest, ice, or activity modification. These treatments aim to alleviate the inflammation and pain associated with the condition.
In combination with these treatments, shoe gear modification can also be beneficial. Patients may benefit from an orthosis to help control hyperpronation, which often is a contributing factor to Achilles tendonitis. For patients with insertional Achilles tendinopathy, shoes that do not cause frictional pain are recommended.
Physical therapy is another conservative treatment method. It is beneficial, especially when strengthening, stretching, proprioception, and anti-inflammatory modalities are used in combination. Heel lifts can also be beneficial in reducing the load on the Achilles during daily activity.
For patients who do not respond well to these options or are noncompliant, immobilization in either a boot or a cast for a short period of time may be beneficial. However, it's worth noting that injecting corticosteroids into the tendon is controversial because of the risk of rupture, especially without immobilization. Some studies suggest injecting platelet-rich plasma or sclerosing agents to help reduce pain and improve function, but supporting data are insufficient to fully support this therapy1.
Surgical Treatments
If conservative treatments fail to provide relief, surgical options may be considered. Surgery for patients with insertional tendinopathy requires removal of the prominent bone, or the Hagland deformity, and debridement of the Achilles tendon. This surgery often involves removing a large part of the Achilles insertion in order to access the bony deformity or calcific tendinosis. The Achilles tendon then needs to be reattached.
When the insertion site is not the source of pain, tendon debridement can reduce symptoms. Other surgical options include tendon transfers or augmentation, specifically with the flexor digitorum longus. Percutaneous options, such as the Tenex and Topaz procedures, are used to break up scar tissue and stimulate vasculature in order to reduce symptoms. However, large studies have not been performed to validate these treatment modalities2.
Conclusion
Achilles tendonitis is a common condition that can significantly impact one's ability to perform daily activities. Fortunately, there are several treatment options available, from conservative to surgical. As with any medical condition, it's crucial to consult with a healthcare professional to determine the most appropriate treatment for your specific situation. Research into new and more effective treatment methods continues, bringing hope for even better management of Achilles tendonitis in the future.
