What are the best treatments for achilles tendinitis?

I feel your pain! Heel pain is a common presentation in the Sports Medicine Centre and certainly we have seen a number of challenging heel/Achilles cases. As Dr Sean mentions there are a number of causes for heel pain that need identification with a good history, examination and baseline investigation. This might include a plain X-ray and an ultrasound examination.

Assuming that you have an Achilles problem, in yourger patients it tends to be mid-portion and in older patients, at the insertion to the heel bone. From the Sports Medicine/MSK perspective, treatment options include:

1. Rehabilition - this includes concentric exercises for the Achilles, stretching of the calf and hamstrings

2. Shockwave therapy on the Achilles

3. Guided injections, such as high volume tendon stripping, prolotherapy and prp injections. Often before the latter two further imaging maybe required.

4. Acupuncture

5. Gait re-training and a podiatry assessment

These are all things that are routinely offered in most sports medicine centres. Having had a number of patients who have undergone prolotherapy for really hard to treat Achilles tendinopathy and retrocalcaneal bursas, these are just some of the treatment options we used.

Hope this helps.

Bw

Dr Dinesh

Achilles tendinitis is a very common cause of posterior heel pain. Nonetheless,’it may not be the only cause of pain. Other possible causes would include retrocalcanea bursitis, paratenonitis, or sometimes a Haglund’s deformity/ Syndrome.

Treatment is based on the correct identification of the pathology (history, physical examination, radiological investigations). Subsequently, treatment can vary.

Anti-inflammatory medication are usually a first line option. It would be good to start on some physiotherapy as well, as one of the main causes could be a tight gastrocnemius/soleues/ Achilles’ tendon complex.

Proper stretching & strengthening would aid in the recovery. Radiofrequency or ultrasound treatment may also be done by the physiotherapist.

If all these conservative management methods fail, surgery may be then indicated. And surgical options vary, from keyhole to open procedures, depending on what the pathology is. It would be useful to seek an opinion from an orthopaedic surgeon. Hope this helps,

Kind regards

Dr Sean Ng