Therapy
The therapy of an inflammation of the Achilles tendon depends on the cause of the inflammation and whether it is an acute or chronic process. In the case of an acute inflammation of the Achilles tendon, it has proven to be best to cool the affected area, put the foot up and stop the strain.In addition, it is advisable to reduce the intensity of the sporting activity responsible for the pain or to temporarily pause completely. It is also possible to switch to another endurance sport such as swimming until the corresponding pain has subsided.
It is also possible to treat the pain with medication. Well-known painkillers such as ibuprofen, diclofenac and paracetamol are available for treatment. Ibuprofen and diclofenac belong to the group of so-called non-steroidal anti-inflammatory drugs, which not only relieve the pain but also have an anti-inflammatory effect.
These drugs can not only be taken in tablet form, but can also be applied locally as an ointment. A further possibility of pain treatment is the injection of a local anaesthetic by a doctor in the area of the tendon. The application of heat using a heat pad about one day after the onset of an acute inflammation of the Achilles tendon has also proven to be effective.
Electrotherapy, whereby iontophoresis and ultrasound therapy should be mentioned here, has also found its place in the treatment of Achilles tendon inflammation. In the acute phase, it is also helpful to elevate the heel of the affected foot and to provide a soft bedding in the shoe. Finally, another option is to perform stretching exercises on the affected side.
The therapy of the chronic inflammation of the Achilles’ marriage differs from the acute therapy. In the case of chronic inflammation, the focus of treatment is primarily on physiotherapy and orthopedic therapy. As in the therapy of acute inflammation, an increase in heel height with insoles as well as massage and stretching exercises are helpful.
For long-term treatment of Achilles tendon inflammation, bandages are recommended, which above all ensure stability in the foot. A distinction is made between bandages with different focal points, which should be weighed individually and lead to relief of the Achilles tendon. If the cause of a chronic inflammation of the Achilles tendon is a heel spur, then it can be eliminated either surgically or by a so-called extracorporeal shock wave therapy (ESWT).
In this case, the doctor applies pressure waves to the affected area in several sessions. If the inflammation cannot be cured with conservative methods such as medication, physiotherapy, insoles and heel elevation, or if the inflammation is too extensive, surgery can be performed as a last option. In such an operation, the inflamed part of the Achilles tendon is removed.
Often a new piece of tendon from the body is inserted into the operated area. After such an operation, extensive follow-up care consisting of physiotherapy and a gradual increase in load is necessary. Walking is therefore only permitted after several weeks.
If Bekhterev’s disease is considered the cause of chronic Achilles tendon inflammation, rheumatological treatment is often necessary in addition to physiotherapy, gymnastics and orthopedic treatment. Medication is used here non-steroidal anti-rheumatic drugs such as ibuprofen or diclofenac, corticosteroids or special anti-rheumatic drugs such as sulfasalazine or so-called biologicals. Decisive in the diagnosis of an inflammation of the Achilles tendon are the medical history and the clinical examination.
In addition, the doctor has various radiological examinations at his disposal, such as ultrasound, X-rays or magnetic resonance imaging, which can confirm the suspected diagnosis of inflammation of the Achilles tendon. During anamnesis it is important to know where, how and since when the pain exists and in which situations the pain occurs. It is also important to find out what kind of sports and other physical activities the patient engages in.
It is also helpful to know whether the patient has any previous rheumatic diseases or metabolic diseases such as gout or diabetes mellitus. During the physical examination, it is first of all important to find out whether any malpositions such as bow legs or knock-knees, differences in leg length or muscle shortening can be detected and can adequately explain the complaints. Palpation of the Achilles tendon typically triggers a pressure pain above the heel bone if the tendon has inflammatory changes.
If the foot is moved actively and passively, pain can also be triggered if the Achilles tendon is inflamed. In addition, a thickening of the Achilles tendon or nodules in the area of the tendon can often be felt. If further diagnostics are planned, an ultrasound of the Achilles tendon is the first step.During this examination, which is based on ultrasound waves and is also called sonography, the doctor can detect compression, calcification, partial tears or even, in the worst case, cracks in the event of inflammation of the Achilles tendon.
If a calcaneal spur or another bony cause for an Achilles tendon inflammation is suspected, an X-ray examination can help to answer this question. On an X-ray image, a heel spur is usually clearly visible. The last radiological procedure is an MRI of the Achilles tendon.
With this examination method, even small changes in the Achilles tendon can be reliably diagnosed. The disadvantages of this method are the costs and the duration of the examination. Finally, certain basic diseases can be detected or excluded by means of laboratory tests. In particular metabolic illnesses such as diabetes mellitus or gout or also rheumatological illnesses such as rheumatoid arthritis or Bechterew’s disease can be recognized here, if they are considered as a cause for an inflammation of the Achilles tendon. In particular, the inflammation values such as the C-reactive protein or the blood sedimentation rate and specific antibodies must be mentioned and checked in the case of rheumatological diseases.
