For the acute phase of Achilles Tendonitis:
Rest:allowing the inflammation to subside and start the healing process.
Immobilization: for those with more significant symptoms. However the length of time of immobilization should be limited to prevent stiffness or muscle atrophy, but this can help in relieving inflammation. In more serious situations, adequate rest may require crutches or immobilization of the ankle. The best treatment of Achilles tendon problems is prevention.
Ice Application: can help stimulate blood flow to the area and relieve the pain associated with inflammation. Apply ice after exercise, as well as several other times over the course of the day. Treatments targeted at controlling inflammation will only help in the treatment of acute inflammatory Achilles tendonitis.
Less acute phase of Achilles Tendonitis:
Use of Shoe Inserts: a heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic shoes and work shoes. They lift up the heel of the foot by a small amount thereby reducing the amount of force on the Achilles tendon. Heel cups inserted into the shoe may help reduce the stress on the Achilles tendon. Use of shoe devices (orthoses) can be used where there are problems with the foot mechanics Products such as arch supports, and custom orthotics can be used to correct for abnormalities, such as overpronation, and help prevent Achilles tendon injuries. It may be useful in these situations to have a biomechanical assessment carried out by a podiatrist.
Stretching the Achilles tendon after exercise, or even at the start of the day but nor prior to exercise), will help to maintain flexibility in the ankle joint.
Anti-Inflammatory Medications: such as ibuprofen help to control the inflammation in and around the tendon.
Manual Therapy: such as osteopathy, and physiotherapy may consist of stretching and specific strengthening exercises that are probably the most helpful treatments for those with Achilles tendon problems. Ensuring adequate flexibility of the muscles of the calf is one priority. Strengthening of these muscles, specifically eccentric strengthening exercises, (this occurs occurs when a muscle is contracting, and an external force is trying to lengthen the muscle.) other treatments available are ultrasound treatment.
However it might also involve assessing the rest of the lower limb, pelvis back mechanics and general postural assessment, in order to help the injury to settle down and to also look preventatively.
Cortisone Injections: Injections can be used for the treatment of Achilles tendon problems, but these are generally avoided because of lack of effectiveness and possible complications.
Surgery: Surgery is usually considered only after a lengthy trial treatments have been exhausted. Options for surgery include removing the damaged portion of tendon (debridement), lengthening of the tendon, or moving the tendon attachment.
Also see Achilles Tendonitis - The Facts and Achilles Tendonosis.
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