Achilles Tendon Pain (Achillodynia): Therapy

General measures

  • As a conservative therapeutic measure: initial immobilization and relief.
  • Avoidance of misuse / overuse of the Achilles tendon.
    • Causes of Achilles tendon insertion tendopathy (pain at the attachment (or origin) of tendons due to abacterial inflammation) may include:
      • Error in training
      • Mechanical overload
      • Increased training intervals
      • Intensive training in ascending terrain
      • Repetitive misuse
  • Provide sufficient periods of recovery, especially if the Achilles tendon already hurts.
  • Check footwear (heel height!) and if necessary consult an orthopedic shoemaker.
    • The worn sports shoe usually reveals a bad posture at first glance.
    • Running shoes should have sufficient shock-absorbing heel structure.
    • Running shoes lifespan note: after 500 to 1,000 running kilometers should buy new running shoes.
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.

Conventional non-surgical therapy methods

  • If physiotherapeutic measures have not brought the desired success (see below): infiltration therapy.

Medical aids

  • In the acute stage:
    • Reduce activity or pause temporarily
    • Insole care: Heel cap, pressure relief, soft cushion insoles; vario-stable shoe.
    • Immobilization by plaster or tape bandage in pointed foot position (in this foot position, the Achilles tendon is relieved).
  • In the chronic stage
    • Heel elevation (insole, between 0.5 and 2 cm) for relief – only for a short time, so that the tendon does not shorten
    • Ointment dressings (only short-term), e.g. with diclofenac (drug from the group of non-opioid analgesics; Cave (Attention! ): nephrotoxic / kidney damaging).

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Strength training (muscle training); later also endurance training (cardio training).
    • Specific strength training exercises in patients with mid-portion achillodynia significantly improved pain and function in patients with Achilles tendinopathy. These were.
      • Eccentric calf muscle strengthening exercises according to Alfredson et al ; this showed no significant differences between eccentric exercises and heavy and slow strength training in terms of pain and function (moderate-grade evidence).
    • Wearing an orthosis or not, had the same effect on pain (moderate-grade evidence) and function (high-grade evidence) after twelve weeks and twelve months, respectively.
  • Creation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

  • For the treatment of degenerative changes in the Achilles tendon, hyperemia (increase in blood flow) is recommended by physiotherapy measures such as ultrasound, high voltage.
  • Consistent stretching of the lower leg (calf muscles) and thus the Achilles tendon:
    • The patient stands barefoot and in the direction of walking on a stair step. The heels should protrude over the edge of the step. Now he assumes the tiptoe position and holds the position for two seconds. Then the heels are lowered below the horizontal of the step, also for a few seconds. This exercise is to be repeated 15 times. Then follows a break of 30 seconds, and following this, the exercise is performed another 15 times.
  • In the context of physiotherapy is shown how to avoid incorrect loading of the foot.
  • Before starting an athletic activity, the Achilles tendon should be kept warm and cooled after completion.
  • Functional leg axis training – to stabilize the leg axis; here, sport-specific positions are taken into account.
  • Special strength training for the calf muscles – to relieve the Achilles tendon.
  • Possibly shock wave therapy – It is used when the previously listed measures have not brought the desired success. Have proven five sessions, which take place at 1-week intervals.

Complementary treatment methods