Active therapeutic measures
The active treatment options for Achilles tendonitis include weight training to strengthen the Achilles tendon and make it less susceptible to future stress. Stretching exercises are also helpful here. Important Strengthening and stretching exercises should only be carried out once the Achilles tendon inflammation has subsided.
Especially too early and too pronounced stretching almost always leads to the transition to chronic Achilles tendonitis. Pronounced stretching is often the self-therapy of many who are confronted with Achilles tendonitis. It is important to ensure that the acute phase of the inflammation has subsided and normal strain is largely possible before the stretching can be started again.
Too early stretching of the calf muscles and thus the Achilles tendon could end in chronic Achilles tendonitis. The Achilles tendon is the strongest and thickest tendon in our body. Therefore, the duration of the healing processes of this tendon is equally extended.
Stretching too early can be detrimental to regeneration, as structures that have just been formed can be destroyed. Depending on the cause of the illness, stretching can nevertheless be recommended, especially as a prophylaxis against Achilles tendonitis. Well stretched calf muscles can support the Achilles tendon and thus prevent shortening and inflammation.
However, this stretching should never be too strong and should only be done after sports activities. Improper stretching can, for example, if “cold” muscles are stretched before sport, cause an Achilles tendon inflammation. In addition to the conservative treatment options, there is an indication for surgery, especially in the case of chronic Achilles tendonitis for more than 6 months.
In the author’s view, operations on the Achilles tendon almost never lead to the desired result. There is controversial discussion whether a local injection of steroids (steroid injection) to the Achilles tendon is beneficial. Although this is very effective in relieving pain, it is also suspected that the injection hinders healing and promotes a possible tear of the Achilles tendon.
- Ultrasound treatment, with the help of which one tries to relieve the Achilles tendon. In addition to this
- Special sports massage techniques (especially cross friction) or
- A rehabilitation programme would be helpful. Cortisone injections are mainly used for people with chronic Achilles tendonitis.
In such long-lasting inflammations, the immune system is permanently busy fighting the inflammation, which causes more and more inflammatory cells to be brought into the tissue. This in turn leads to many waste products, which can further advance the inflammation. Therefore, one tries to temporarily shut down the immune system at the site of the Achilles tendon inflammation by injecting cortisone.
This allows the tissue to recover somewhat and also reduces the pain. More about this:
- Cortisone syringe – areas of application and side effects
Chronic or long-lasting Achilles tendon inflammation usually results in mutually reinforcing inflammatory processes in the Achilles tendon. With laser therapy, high-energy light can be applied very specifically to the Achilles tendon.
This triggers a so-called biostimulation of the cells involved in the inflammation. By means of this biostimulation, the metabolism of these cells is changed 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.
Thus it usually lasts for several weeks to months. Ultrasounds are waves that oscillate beyond human perception. Due to their specific wavelength, the ultrasound waves penetrate well into the tissue and can thus transfer their energy directly to bones, tendons, muscles and ligaments.
Ultrasound therapy makes use of this function. Here, the ultrasound waves are supposed to transfer their energy to the Achilles tendon, which causes a warming that stimulates the metabolism and the blood circulation in the tendon. Due to the more active metabolic position, the body can better fight Achilles tendon inflammation.
At the same time, the improved blood circulation favours the removal of waste products that are produced during the fight against inflammation. Probably the most potent and best method for Achilles tendon inflammation is the so-called shock wave therapy. The shock wave therapy is a complicated and high-energy therapy, which only applied correctly, brings the desired success.
Therefore, such shock wave therapy should only be carried out in centres that focus on this therapy. Shock wave therapy (also: extracorporeal shock wave therapy; ESWT) is based on the generation of high-energy pressure waves, which 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 orthopaedics. With the help of these pressure waves, a wide variety of diseases affecting the ligaments and tendons of the musculoskeletal system can be treated. For some time now, shock wave therapy has also been used to treat Achilles tendon inflammation.
A study from the USA shows that, compared to a conservative therapy recommendation, shock wave therapy performs significantly better. Depending on the study, the success rate of the therapy is up to 80%. The shock waves accelerate the regeneration of the tendon, which can significantly speed up the healing process in the case of Achilles tendonitis.
Scientific studies show that the therapy increases the blood flow at the treated area and initiates a healing process. Shockwave therapy is usually carried out in a practice for orthopaedics or sports medicine, but also in physiotherapy. A liquid, usually a gel, is applied to the affected area so that the shock waves can penetrate directly into the affected region without loss of energy.
The treatment with the shock waves usually takes 5-10 minutes. Most of those affected do not find the treatment painful, although the shock waves are clearly noticeable and are not always perceived as pleasant. Patients with an increased tendency to bleed should inform their doctor or physiotherapist before starting treatment.
In principle, Achilles tendonitis is initially treated conservatively, i.e. without surgery. Only when the conservative treatment options have been exhausted do patients resort to surgery. The goal of such an operation is primarily to remove areas that promote inflammation.
This includes, for example, the bursa of the Achilles tendon, from which inflammation can always arise. Often, small ossifications in the tendon also occur in the course of Achilles tendon inflammation. These can also be removed surgically.
The operation itself can be performed under local or general anaesthesia. The procedure depends mainly on the state of health of the person concerned and the size of the surgical procedure. The operation itself can usually be performed minimally invasive, i.e. only through small skin incisions. In case of particularly pronounced inflammation, a longer skin incision may be necessary. After the operation, the affected lower leg is usually immobilised in a splint for several weeks, followed by treatment with painkillers and physiotherapy.