Treatment depends upon the injury: treatment for Achilles tendonitis, tendinosis and tenosynovitis is significantly different from the treatment for a partial or full Achilles tendon rupture.
All Achilles Tendon Injuries
Prior to starting any treatment check with a doctor to be sure that the injury is correctly diagnosed and that the treatment is appropriate:
• Review Injury Types, Causes and Prevention to be sure you understand which type of Achilles tendon injury you have, the probable cause(s), and the steps that might have prevented the injury. Incorporate these concepts into your treatment and post recovery habits to speed your recovery and prevent a re-occurrence of the injury.
• Review footwear. It is almost always beneficial to immediately replace the sport shoes or shoes you were wearing when you became injured. The same may be true for some of your other sports shoes and shoes as well. For a grade 1 injury try new sports shoes and temporarily adding a heal lift to sports shoes and shoes. For a grade 2 injury consider an orthotic. For an understanding of injury grades see types of injury, for an understanding of sports shoes and shoes see footwear.
Achilles Tendinosis (Achilles Tendinopathy), Achilles Tendonitis, Achilles Tenosynovitis, and Tennis Leg
Treatment for each includes five simultaneous steps. In cases of tendonitis an anti-inflammatory may also be used.
1 – Relative rest. Stop doing the activity that caused the injury for between a week and a few months, depending upon the degree of degeneration. Relative rest should last at least 1 week for a grade 1 or 2 injury, at least 3 weeks for a grade 3 injury, and at least 1 month for a grade 4 injury. For an understanding of injury grades see: injuries. During the relative rest period also stop performing activities and sports that are similar to the one that caused the injury, i.e. soccer is similar to running, handball is similar to tennis, etc.
Achilles tendinosis is not an excuse to get out of shape: relative rest is the treatment, not total rest. During the relative rest period do alternate sports that are easy on the Achilles tendon, such as swimming, moderate cycling, upper body weight lifting, etc.
After the relative rest period, resume gradually. For example, if you are a runner with a grade 3 injury resume with jogging until you are sure that you are down to at least a level 2 injury, then resume running moderate distance with no speed work or hills until you are down to at least a grade 1 injury, then resume running at the same intensity as prior to the injury.
2 – Stretch the calf muscles for 20 or more minutes per day. If the other leg muscles, the hip muscles, and the back muscles are tight, they may be causing tightness of the calf muscles, so stretch these other muscles as well. In addition to standard stretching, muscles can also be stretched by strengthening their opposing muscle group. For example, strengthening the anterior tibialis, the small muscle group on the front of the lower leg, stretches the calf muscles. As part of stretching, consider massage.
3 – Eccentric strengthening of the leg muscles, particularly the calf muscles. Do daily or every other day calf raises on a stair or using a calf raise machine in a gym. Start slowly using just your body weight doing three sets of 10 or 15. When this can be done without pain, gradually increase the speed, number of repetitions per set, amount of weight, and number of sets.
Concentrate on the eccentric rather than the concentric portion of the exercise (the calf lowering rather than the calf raising portion of calf raises). On each repitition, be sure to go all the way down for a full stretch of the Achilles tendon. Do the calf raises after, rather than before, any other exercises that you are doing.
4 – Physical therapy. Therapies applied by professional physical therapists to repair tendon degeneration include: ultra sound, electric stimulation, and laser photostimulation.
5 – Ice therapy. Apply ice to reduce the degeneration. Ice should not be applied directly to the skin, use an ice pack instead. Apply the ice pack to the Achilles tendons after exercise or physical therapy. Apply as often and as for as long as possible.
Avoid anti-inflammatory and pain killing drugs. The anti-inflammatory drugs will not help because Achilles tendinosis is a degenerative injury rather than an inflammation (see injuries). The pain killing drugs will mask the problem, which is likely to cause the degeneration to get worse. In addition to being ineffective, anti-inflammatory and pain killing drugs are also expensive.
Consider non-invasive medical approaches and surgery if all the above steps have been taken completely and repeatedly, and the Achilles tendinosis has not improved for at least six months. In the very worst cases of Achilles tendinosis, surgery may be required, but only as a very last resort.
Researchers disagree about the benefits of nitric oxide (Glyceryl Trinitrate) patches, and Electronic Wave Shock Treatment (EWST). EWST is also known as Electronic Shock Wave Therapy (ESWT) and extracorporeal shockwave therapy. Limited research has found that Iontophoresis with Dexamethazone (delivery of dexamethasone through the skin via an electrical current) is an effective treatment, however the study’s small sample size limits the possibility of drawing definite conclusions. Note the warnings about cortisone (Dexamthasone is a corticosteroid) in Causes of Achilles Tendon Injury. Each is considered a non-invasive medical approach that you may want to discuss with your doctor.
As a last resort, consider surgery. Surgery involves cutting away the areas of degeneration. The most common approach is to remove the outer area or sheath of the tendon and then cut out the degenerative areas. The scalpel is inserted into the degenerative area of the tendon and then, while the scalpel is inserted, the patient flexes and extends the foot. The process is then repeated just above, below, to the left, and to the right of the original insertion. Again, fully explore other option before considering surgery.
Achilles Tendon Rupture (Achilles Tendon Tear)
Achilles tendon rupture can be successfully treated with or without surgery: both methods have proven to be effective. Surgical treatment is also known as operative treatment, non-surgical treatment is also known as conservative and non-operative treatment. There is no consensus on: surgery vs. no surgery, nor is there a consensus on the best surgical and best non-surgical approaches to treating Achilles tendon rupture. Surgical treatment of acute Achilles tendon rupture significantly reduces the risk of re-rupture compared with non-surgical treatment, but produces significantly higher risks of other complications such as infection, adhesions and disturbed skin sensibility (numbness and tingling). The research supports immediate immobilization for both the surgical and non-surgical approaches. To avoid surgical risks, try non-surgical treatment first.
Non-surgical treatment of Achilles tendon rupture involves: immobilization, casts or wraps, and physical therapy. For non-surgical treatment of Achilles tendon rupture, weight-bearing casts appear to offer outcomes that are at least equivalent to outcomes of non-weight bearing casts.
Surgical treatment of Achilles tendon rupture involves: immobilization, surgery, casts or wraps, and physical therapy. Surgery to repair a ruptured Achilles tendon can either be open (single large incision) or percutaneous (several small incisions). After making the incision or incisions, the surgeon sews the Achilles tendon back together. The risks associated with open surgery may be reduced by percutaneous surgery. There is no consensus on the best surgical techniques for Achilles tendon rupture, but some techniques – such the triple bundle or Epitendinous cross-stitch weave augmentation – provide a stronger connection. Post surgery, wraps have an advantage over casts. Research suggests postoperative protective weight bearing and the use of protective devices that allow for postoperative mobilization.
Casts and wraps can be used to support Achilles tendon rupture recovery. They can be plaster of Paris casts, medical wraps, boots, walking boots, weight bearing, or non-weight bearing. They allow various degrees of movement, and can be set at various levels of Achilles tendon stretch (toes pointing down for less stretch, even for normal stretch, toes pointing up for more stretch). Adjustments, or new casts and wraps, can be applied as recovery progresses.
For both surgical and non-surgical treatment of Achilles tendon rupture, physical therapy will include the same slow stretching and gradual strengthening described earlier on this page for Achilles Tendinosis (Achilles Tendinopathy), Achilles Tendonitis, Achilles Tenosynovitis, and Tennis Leg.
Achilles Tendon Laceration and Crushing
Achilles tendon laceration injuries vary dramatically in both their severity and the amount of damage done to other parts of the foot and leg. The same is true for crushing type Achilles tendon injuries. A physician should be consulted.
Cross Training and Cross Treatment When in a Cast
Blood circulation to an injured Achilles tendon in a cast may be improved by applying acupuncture or heating treatments to the other Achilles tendon. Exercising the leg that is not in the cast will reduce atrophy of the leg in the cast.