For Achilles tendinitis, NYU Langone experts may recommend a variety of nonsurgical treatments, including rest or immobilization, ice, compression, elevation, pain medication, and physical therapy.
These treatments may also be recommended for older, less active adults who have ruptured their Achilles tendon and those who cannot have surgery because of underlying conditions such as heart disease.
Your doctor uses a combination of rest or immobilization, ice, compression, and elevation, called the RICE regimen, for several weeks after diagnosis of an Achilles injury. Your doctor can determine how long you should participate in a RICE regimen depending on the type and severity of Achilles injury.
A walking boot may help you to keep your foot immobile, allowing the Achilles tendon time to heal. Doctors may recommend immobilization for two or three weeks after an Achilles tendinitis diagnosis. Crutches can help keep weight off the foot.
Usually, immobilization for 12 weeks or more is needed for an Achilles rupture, especially if the tendon has been completely severed. The ends of the severed tendon need to be carefully positioned soon after injury for the best chance of healing using this approach.
Applying ice to your injury 2 to 3 times daily for 5 to 10 minutes at a time can help to alleviate pain and swelling from Achilles injury. During the first few days after injury, wrapping a flexible bandage around the heel area and ankle may reduce swelling. Elevating the foot 3 times a day for 15 minutes can also help with swelling.
Until inflammation of the Achilles tendon fully subsides, your doctor may recommend avoiding activities that put stress on the heel and foot.
Placing orthotics in your shoes may help to alleviate pressure on the Achilles tendon when walking, running, or participating in other physical activities. Your doctor may recommend using a simple over-the-counter orthotic that slightly lifts your heel. Prescription orthotics are also an option.
Your doctor may recommend taking nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, to reduce inflammation and relieve pain caused by an Achilles injury. These medications are typically recommended for a few weeks while the body heals.
Physical and occupational therapists at NYU Langone Orthopedic Center can customize a rehabilitation program that takes into account your daily activities or any goals you have for returning to strenuous exercise. Physical therapy can help rebuild strength, flexibility, and range of motion in the foot and ankle.
You may need to participate in exercises that keep most of the weight off your foot with a walking boot for the first part of the rehabilitation program. Weight-bearing exercises are gradually added as your Achilles tendon heals.
NYU Langone doctors may recommend four to six weeks of physical therapy for Achilles tendinitis, at which time your doctor assesses the injury and determines whether additional therapy is needed for a full recovery.
Rehabilitation programs for Achilles rupture may take up to six months for return to low-impact activities like walking and hiking, while higher-impact activities like soccer and football may be possible after nine months. Specialists at NYU Langone’s Sports Performance Center can help refine your sports activity to protect your Achilles from future injury.
If a rehabilitation program does not help with Achilles tendinitis, then your doctor may discuss surgery with you. A ruptured Achilles tends to heal well after a comprehensive rehabilitation program. However, more-active patients who want better strength in the leg and foot may opt for surgery as an initial treatment.
For a platelet-rich plasma injection, your doctor first takes a small amount of blood from a vein in your arm and uses a centrifuge to separate the platelets and growth factors from other parts of the blood. This takes about 15 minutes. The doctor then injects platelet-rich liquid, called plasma, into the Achilles tendon under ultrasound guidance.
The injection site may be sore for a few days to a week after treatment. Your doctor may recommend that you wear a walking boot to keep pressure off your calf, ankle, and foot. You may also need to avoid anti-inflammatory medications for several weeks after an injection. The platelet-rich plasma injection stimulates the body’s inflammatory response, an important part of healing that could be hindered if anti-inflammatory drugs are taken.
Shock wave therapy, also called extracorporeal shock wave therapy, may help Achilles tendonitis to heal. For this in-office procedure, doctors use a handheld device that delivers ultrasonic waves to the tissue to stimulate healing. Typically, this approach requires 5 treatments of 15 minutes over several weeks.
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