Orthopedics-Online

Therapy of achilles tendinitis

introduction

Therapy for Achilles tendonitis is difficult. Even in antiquity, the Achilles heel can be seen as a weak point. Even today, the treatment of the Achilles tendon is one of the most difficult therapies in orthopedics. For this reason, treatment should be carried out as early as possible so that the inflammation does not become chronic.

Overview of therapy options

The following treatment options are available for treating acute Achilles tendonitis:

cooling
Pain relievers (including anti-inflammatory drugs such as ibuprofen or aspirin)

As a long-term therapy option to prevent the inflammation from worsening or in the case of pre-existing chronic inflammation:

Heel wedges
Bandages
physical therapy
Cortisone injections
Tape dressings with kinesio tape
Laser therapy
Ultrasound therapy
surgery

Appointment with an expert in Achilles tendonitis?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

Athletes (joggers, soccer players, etc.) are particularly often affected by the Achilles tendonitis disease. In many cases, the cause of the Achilles tendonitis cannot be identified at first. Therefore, the treatment requires a lot of experience. I focus on Achilles tendonitis.

The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

Acute self-therapy measures

There are several methods of treating Achilles tendonitis that anyone can do without having to see a doctor.
This is one of the simplest methods of treating Achilles tendonitis

Resting the foot (in the sense of a sports break)

but in any case the reduction in the amount of training.
Movements that cause pain should be avoided, but the foot should also not be completely immobilized. In addition, the Achilles tendon should be cooled.

Raising the heel

The Achilles tendon is relieved by raising the heel. Therefore, shoes with heels are ideal. But also special Achilles tendon bandages relieve the heel with an integrated wedge.

Cryotherapy

This is particularly recommended in the acute stage of Achilles tendonitis for the short-term reduction of pain and swelling.

Cold therapy

Cold therapy is a very important therapeutic tool, especially at the beginning, i.e. in the acute phase of Achilles tendonitis.

Such inflammation is usually characterized by pain, redness, overheating, swelling and impaired function of the tendon. In particular, the redness and overheating can be reduced with cold therapy. This also reduces pain, which improves functionality. Cold can be applied to the Achilles tendon in the form of an ice pack or ice pack. However, these should be covered with a thin cloth or towel so as not to damage the skin from the cold.

Medication

Therapy for Achilles tendonitis is usually carried out conservatively, i.e. with medication. If the Achilles tendon is inflamed, surgery is only carried out in very rare cases. In most cases, the inflammation can be completely cured with the use of certain medications in connection with protecting the tendon.

Conservative therapy for Achilles tendonitis is mainly based on a specific group of substances that have both a pain-relieving and an anti-inflammatory function. So-called NSAIDs (non-steroidal anti-inflammatory drugs) such as acetylsalicylic acid, ibuprofen and diclofenac help the affected patients in two ways. Since severe pain can occur with an Achilles tendonitis, it is usually necessary to take pain medication in the acute phase of the disease. At the same time, the drugs can have an active influence on the healing process of the Achilles tendon due to their anti-inflammatory effects. It should be noted that the medication does not contain cortisone and so the typical side effects of anti-inflammatory drugs containing cortisone do not occur here. Medicines with the active ingredients ibuprofen and diclofenac are particularly suitable for the conservative treatment of Achilles tendonitis.

Other drugs that have an effect on curing Achilles tendonitis are anti-inflammatory drugs that contain cortisone. Since therapy with cortisone is usually associated with side effects, this is only considered if the disease is severe. Depending on the healing process, cortisone injections may even be necessary to get the tendon inflammation under control.
In general, the treatment of Achilles tendonitis should best be carried out in consultation with the attending physician. This is especially true when there is pain. The doctor can best assess the individual clinical picture and the appropriate therapy.

You may also be interested in the following article: Achilles tendonitis caused by antibiotics

Anoint

In addition to other therapies, the application of certain ointments is a popular method of treating Achilles tendinitis. The actual effect of using ointments on Achilles tendonitis is highly controversial.

Due to the evaporation of the ointment on the skin, each ointment that is applied has a cooling effect on the corresponding area. Ointments containing active ingredients often contain anti-inflammatory substances such as ibuprofen or diclofenac. It is important to note that the active ingredients not only work at the place where they are applied, but are first absorbed by the skin and distributed throughout the entire circulation. So only a very small part of the active ingredient can actually work on the Achilles tendon. Drugs in tablet form are better here, as the dose can be estimated much better with this dosage form.
Other ointments without chemically produced active ingredients such as tea tree oil, horse ointment or arnica ointment, like any ointment, have a cooling effect on the applied area. A further healing effect with these ointments has not yet been scientifically proven and is therefore highly controversial. In summary, therapy for Achilles tendonitis should not take place solely through the application of ointments, but instead a suitable, individual therapy should be discussed with the attending physician.

Long-term treatment options

During the healing process, you can have a

Wear heel insert,

which reduces the tensile forces on the Achilles tendon and thus accelerates healing. After healing, however, the inlay must be removed again, otherwise the Achilles tendon may shorten permanently.
Especially with runners, it is advisable to do a treadmill analysis when the first complaints are made and then, together with the specialist advisor, select a suitable shoe that is appropriate to the shape of the foot and possibly can relieve the Achilles tendon.
Depending on the results of the running analysis, prevention can be carried out through individual running insoles.
Furthermore, adjustments to the running style can be made that put stress on the Achilles tendon.

Bandages

Special Achilles tendon bandages can relieve the Achilles tendon.

Kinesio taping

A special form of tape, the so-called kinesio tapes, accelerates the healing of the tendon.

Kinesiotape is an elastic tape that can be attached to muscular areas of the body in order to improve the stability of the affected area and the chances of recovery. The mode of action is sometimes controversial, but kinesiotape is a frequently used therapy in the context of, for example, Achilles tendinitis. Kinesiotape is a way to support the Achilles tendon and thus reduce the discomfort somewhat. The correct application of the tape should be carried out by a physiotherapist or another person who has experience with the subject. Care should also be taken to ensure that the tape can provide the required stability through multiple layers of systematic attachment. The tape can be useful in the first phase of inflammation in order to be able to carry out everyday movements such as climbing stairs without symptoms, and in the last phase to enable athletes to resume training.

You can find much more information on this under our topic:

Taping an achilles tendinitis

Bandages

Bandages can be used to reduce the stress on the tendon in the case of Achilles tendonitis. The Achilles tendon is stressed with every step when walking, for example, as it transfers the force required to push the foot off the ground. A bandage can stabilize the ankle. As a result, the ankle joint is guided somewhat by the support with every step, so that the Achilles tendon has to transfer less stabilization work.

Further information on this topic can be found at: Bandage for achilles tendonitis or ankle bandage

Heel wedges

The treatment of Achilles tendonitis using heel wedges aims to reduce the stress on the Achilles tendon.

With a heel wedge, the heel is slightly higher than the ball of the foot with every step, which means that the Achilles tendon is less stretched than is otherwise the case. It also reduces the pressure on the Achilles tendon when the foot is pushed off the ground. The heel wedge can therefore be used in the acute phase of inflammation, but it is also suitable to prevent renewed Achilles tendinitis.

You may also be interested in this topic:

Insoles for shoes

Active therapeutic measures

Active treatment options for Achilles tendonitis include one

Ultrasound treatment, with the help of which one tries to relieve the Achilles tendon. In addition to this, you can
physical therapy
special sports massage techniques (especially transverse friction)
or
a rehabilitation program can be helpful.

After the pain has subsided, strength training is recommended to strengthen the Achilles tendon against future stresses and make it less susceptible.
Stretching exercises are also helpful here.

Important
Strengthening and stretching exercises may only be performed after the Achilles tendonitis has subsided. In particular, stretching too early and too much almost always leads to the transition to chronic Achilles tendinitis.

Pronounced stretching is often the self-therapy of many who are confronted with an Achilles tendonitis. It is important to ensure that the acute phase of the inflammation has subsided and that normal stress is largely possible before you can start stretching again. Too early stretching of the calf muscles and thus the Achilles tendon could result in chronic Achilles tendonitis. The Achilles tendon is the strongest and thickest tendon in our body. This increases the duration of the healing process for this tendon. Stretching too early can damage regeneration as it can destroy structures that have just been formed.

Depending on the cause of the disease, stretching can still be recommended, especially as a prophylaxis against Achilles tendonitis. A well-stretched calf muscles can support the Achilles tendon and thus prevent shortening and inflammation. However, this stretching should never be done too vigorously and especially only after exercise. Improper stretching, if, for example, stretching with "cold" muscles before exercise, can cause Achilles tendonitis.

In addition to the conservative treatment options, there is an indication for an operation, especially for chronic Achilles tendinitis for more than 6 months.
From the author's point of view, operations on the Achilles tendon almost never lead to the desired result.

It is controversial whether a local injection of steroids (Steroid injection) to the Achilles tendon is beneficial. Although this is very effective in relieving the pain, there is also a suspicion that the syringe will hinder healing and promote a possible rupture of the Achilles tendon.

Cortisone injections

Cortisone injections are mainly used for people with chronic Achilles tendinitis.

With such long-lasting inflammations, the immune system is constantly busy fighting the inflammation, which brings more and more inflammatory cells into the tissue. This, in turn, creates a lot of waste, which can further fuel inflammation. Therefore, one tries to temporarily shut down the immune system at the site of the Achilles tendinitis with cortisone injections. This allows the tissue to recover a little and the pain is also reduced.

Laser therapy

Chronic or long-term inflammation of the Achilles tendon usually leads to mutually reinforcing inflammatory processes in the Achilles tendon.

Laser therapy can be used to target the Achilles tendon with highly energetic light. This triggers what is known as biostimulation of the cells involved in the inflammation. This biostimulation changes the metabolism of these cells so that they are better able to counteract the inflammation. Such laser therapy should usually be carried out in several sessions, initially at intervals of a few days, later weekly. As a result, it usually lasts a few weeks to months.

Ultrasound therapy

Ultrasound is waves that vibrate beyond human perception. Due to their specific wavelength, the ultrasonic waves penetrate the tissue well and can thus transfer their energy directly to bones, tendons, muscles and ligaments.

This function is used in ultrasound therapy. The ultrasound waves are supposed to transfer their energy to the Achilles tendon, heating up, which stimulates the metabolism and blood circulation in the tendon. Due to the more active metabolism, the body can better fight Achilles tendonitis. At the same time, the improved blood circulation favors the removal of the waste materials that arise in combating inflammation.

Shock wave therapy

Probably the most potent and best method for Achilles tendonitis is so-called shock wave therapy.
Shock wave therapy is a complex and high-energy therapy that, only when applied correctly, will bring the desired results. Therefore, such shock wave therapy should only be carried out in centers that focus on this therapy.

Shock wave therapy (also: extracorporeal shock wave therapy; ESWT) is based on the generation of high-energy pressure waves that are very similar to known sound waves. It was first used to remove kidney stones non-surgically.

Nowadays it is used in many areas of medicine, and especially in orthopedics. With the help of these pressure waves, a wide variety of diseases that affect the ligament and tendon system of the musculoskeletal system can be treated. For some time now, Achilles tendonitis has also been treated with shock wave therapy. A study from the USA shows that, compared to a conservative therapy recommendation, shock wave therapy scores significantly better. Depending on the study, the success rates of the therapy are up to 80%.

The shock waves accelerate the regeneration of the tendon, which can significantly accelerate the healing process in the case of Achilles tendonitis. Scientific studies show that the therapy increases blood flow to the treated area and initiates a healing process. Shock wave therapy is usually carried out in an orthopedic or sports medicine practice, but also in physiotherapy. A liquid, usually a gel, is applied to the affected area so that the pressure waves can penetrate directly into the affected area without any loss of energy. The shock wave treatment usually lasts 5-10 minutes. Most of those affected do not perceive the treatment as painful, although the pressure waves can be clearly felt and are not always perceived as pleasant. Patients with an increased tendency to bleed should inform their doctor or physiotherapist before starting treatment.

Achilles tendonitis surgery

In principle, Achilles tendonitis is initially treated conservatively, i.e. without surgery. Only when the conservative treatment options have been exhausted do you resort to surgery.

The aim of such an operation is primarily to remove inflammatory areas. This includes, for example, the bursa of the Achilles tendon, which can cause inflammation again and again. Often there is also small ossification in the tendon as part of the Achilles tendonitis. These can also be surgically removed.

The operation itself can be carried out under local or general anesthesia. The procedure depends primarily on the state of health of the person concerned and the size of the surgical procedure. The operation itself can usually be carried out in a minimally invasive manner, i.e. only through small skin incisions; if the inflammation is particularly pronounced, a longer skin incision may be necessary. After the operation, the affected lower leg is usually immobilized in a splint for a few weeks, followed by treatment with painkillers and physiotherapy.

Home remedies for therapy

In the treatment of Achilles tendonitis, cooling agents are mainly used in the first phase.

This can be curd or cabbage rolls, for example. On the one hand, they cool because the quark or cabbage are cold, and on the other hand the wraps are moist, which means that cooling develops through the evaporation of the moisture. Anti-inflammatory home remedies are also used to counteract Achilles tendonitis. Various essential oils can be applied to the affected area. Apple cider vinegar wraps are also helpful as they inhibit inflammation and cool with their moisture.

Read more about this: Home remedies for Achilles tendonitis

homeopathy

Treatment of Achilles tendonitis with homeopathic remedies cannot be recommended due to the lack of scientific evidence of their effectiveness. Remedies that are mostly used for this clinical picture are arnica or bryonia.

In principle, there is nothing against taking homeopathic remedies if a therapy recommended by a doctor is carried out at the same time. So it is recommended to see a doctor, preferably an orthopedic surgeon, who will take care of the disease and recommend therapy. This can be reported by the desire to take a homeopathic remedy for support. In this way, the harmlessness of the respective homeopathic remedy can be clarified in conjunction with the intake of the medication recommended by the respective doctor. Treatment of Achilles tendonitis with homeopathic remedies alone is not recommended. This is especially true if there is pain and the symptoms do not improve after a few days.

When should a doctor be consulted?

A specialist in orthopedics should be consulted, especially if self-therapy does not help in the short term.
Most sports physicians first measure the thickness of the Achilles tendon, as the thickness is an indication of the severity of the injury or illness. Since inflammation in the classic sense is the cause of the symptoms in the rarest of cases, as would be the case with rheumatism, for example, prescribing anti-inflammatory drugs such as ibuprofen or diclofenac is increasingly being avoided.

Together with the doctor, after a detailed examination, a plan can be drawn up to alleviate the symptoms.
Particularly in the case of acute complaints, it is precisely analyzed what additional stress has occurred recently and how this can be avoided or minimized in the future.
As a first measure, the Achilles tendon can also be supported with special adhesive plasters (taped) become.
The orthopedic surgeon / sports doctor must only recommend wearing a cast in absolutely exceptional cases. This situation can exist when a direct tear of the Achilles tendon threatens.

Duration of therapy

Therapy for Achilles tendonitis is often tedious. The duration usually depends on how strictly the affected people adhere to an initial sports ban and how cautiously the return to work is handled.

Usually the acute inflammation symptoms can be alleviated within a few weeks. Afterwards, however, irritations can occur again and again during physical exertion for months. Some people still struggle with the disease after six months to a year.

Illustration of achilles tendinitis

Achilles tendinitis
is an overload violation

Achilles tendon -
Tendo calcaneus
Heel bone -
Calcaneus
Three-headed calf muscle -
Triceps surae muscle

consisting of:
- Internal calf muscle -
Gastrocnemius muscle,
Caput mediale
- External calf muscle -
Musculu gastrocnemius,
Caput laterale
- clod muscle -
Soleus muscle

Typical causes of a
Achilles tendonitis
(see pictures):

- running (too many training kilometers,
running speed too fast)
- Running uphill
(hilly terrain), climbing stairs
- Footwear (high heels)