Therapy /Treatment
In many cases no special treatment is necessary and a spontaneous healing of an achillodynia occurs. The main procedure in the presence of this degenerative disease is the rapid reduction of the triggering physical stress. The sport that leads to the strain should be quickly reduced or avoided completely.
Furthermore, an appropriate shoe inlay should be selected and manufactured to counteract the overloading of the Achilles tendon during running. The further treatment of an Achillodynia is conservative in all cases. Surgical therapy is not necessary: the treatment of an Achillodynia is successful in 70-80% of cases and patients can resume their sports programme after an appropriate treatment period.
- Symptomatic therapy is initiated by immobilising the leg during a painful episode. – Measures that promote blood circulation to the tendon should also be taken. These include stimulation current treatment and keeping the foot and heel warm during sports activities.
- During non-sporting intervals, however, an attempt can be made to reduce the pain by applying cold. – All orthopaedic painkillers are available in the form of medication, but continuous application should be avoided. – In addition to the non-drug treatments, a mature physiotherapy should be carried out, which deals mainly with the incorrect loads and corresponding alternative movements.
Physiotherapy is, among other things, an effective method of treating achillodynia, and it is an effective method of eliminating the symptoms that occur in the clinical picture of achillodynia. Depending on the stage of the Achilles tendon inflammation, different methods of physiotherapy are used. Thus, if pain symptoms exist and especially if other symptoms such as redness or swelling of the tendon occur simultaneously, gentle forms of therapy should be chosen.
In general, the cause of the disease should first be determined so that it can be avoided or eliminated. Physiotherapy can support the healing process after elimination of the triggering cause and can be a sensible therapy option. However, it is important that the treating physiotherapist teaches exercises that can also be done at home.
Especially by consistently doing these exercises, also at home, an accompanying physiotherapy for an Achillodynia can be positive for the individual healing process. The therapy of Achillodynia with the help of a “tape”, also called kinesiotape, should have a positive effect on the healing process as well as an improvement of the stability of the Achilles tendon. The tape is attached to the foot and lower leg in such a way that the tendon is stable.
Whether such a therapy with a tape can actually show a scientifically proven effect is controversial, however. In general, treatment with tape cannot cause any damage in the presence of achillodynia. It should be noted that the foot in question should not be subjected to any load at first, even if this would subjectively be possible with the tape.
This is especially important for athletes who often suffer from achillodynia. The risk of aggravation of the disease if the foot is continuously strained despite the complaints is very high in these cases and should be avoided. Thus, despite treatment with the tape, the triggering cause of the disease should be sought.
Only by eliminating the triggering factor can a recurrent achillodynia be prevented for a long time. A further therapy option for persistent, therapy-resistant achillodynia is the so-called extracorporeal focused shock wave therapy (EWTS). It is not one of the treatment methods that are reimbursed by the health insurance company, so if desired, it must be paid for privately by the patient.
The health insurance company does not recognize shock wave therapy for the treatment of achillodynia because a clear and definitive proof of effectiveness is missing. So far, no scientific study has succeeded in proving a direct healing effect. Nevertheless, there is some evidence that extracorporeal shock wave therapy could be helpful in the treatment of achillodynia, which is why there are some doctors who offer and recommend this therapy option in certain cases.
Shock waves are short pressure waves that propagate at the speed of sound after being emitted from a small device that remains outside the body. In the orthopaedic field, low-energy shock waves are mainly used. These are in contrast to the somewhat better-known high-energy shock waves, which are used, for example, for minimally invasive gallstone fragmentation.
The shock waves propagate in softer tissue – for example water, but also fat, muscles and other soft tissues – without loss of energy; they virtually glide through these structures. However, if the shock waves come into contact with a hard substance – for example a bone or a hardened, thickened tendon – the propagation is stopped and the energy of the wave is discharged. The released energy remains at the point of impact.
A healing effect can possibly be explained by a kind of stimulation of cells by the shock waves. Such a stimulus could lead to the cells being stimulated to renew and regenerate themselves. Under certain circumstances, the metabolism of the cells is activated, which could lead to faster healing.
Nevertheless, many patients suffering from pain report a significant improvement in their symptoms, so that shock wave therapy remains a pleasant therapy option for the patient, as no further imaging is required and it can be carried out in an uncomplicated and painless manner. Since it is generally without great risk, there is little to prevent an attempt at therapy for long-term therapy-resistant complaints. However, as already mentioned, there is no clear scientific evidence of its effectiveness and mechanism of action.
Even though many patients have very positive experiences, one should therefore be wary of miracle cures by private providers and critically question every further (sometimes very expensive) treatment session. Ultimately, it is up to each patient to decide on the costs of such a therapy and its possible benefits. Bandages, similar to a treatment in a plaster cast, can be used to treat achillodynia as soon as other forms of protection and immobilization are difficult or impossible to implement.
A fixation with bandages in the so-called toe position, in which the toe position is imitated, leads to relief directly after the acute pain event and thus relieves pain. Sports bandages can also be worn after an acute achillodynia has healed, after adjustment and explanation by an experienced orthopaedic surgeon, for stabilisation and support to avoid future overloading and irritation. However, bandages of all kinds thus always remain an additional component of the treatment concept and are rarely used alone.
Certain homeopathic medicines are attributed a positive effect on the healing of Achillodynia. Typical homeopathic remedies that are frequently recommended for this symptom pattern are Arnica, Bryona, Rhus toxicodendron or Apis mellifica. None of these homeopathic remedies has been scientifically proven to be effective.
For this reason, treatment with homeopathic remedies alone cannot be recommended for an existing achillodynia. Especially if the symptoms do not subside or get worse after a few days, or if redness, swelling or a warmed skin appears, a doctor should be consulted to clarify the cause. During the course of therapy, however, there is nothing to be said against taking homeopathic remedies at the same time, provided that the instructions and therapy plans of the doctor treating you are followed at the same time. It is important to avoid stress on the Achilles tendon at first to prevent the disease from worsening.
