Achilles Tendonitis Treatment in Raleigh, NC
Achilles tendonitis is inflammation and/or degeneration of the Achilles tendon. At Wake Non Surgical Ortho, Dr. Kanaan provides non-surgical treatment options to patients suffering from Achilles tendonitis. He will take the time to provide you with a proper diagnosis to determine the best treatment option for you. For more information, contact our office at (919)719-2270 and schedule an appointment today!
What Causes Achilles Tendonitis?
Most injuries of the Achilles tendon are overuse conditions caused by repetitive motion associated with poor biomechanics. Improper footwear, improper warm up, inflexibility of the calf muscles, and improper cool down are factors that increase the chance of Achilles tendonitis.
How Does Dr. Kanaan Diagnose Achilles Tendonitis?
Diagnosis of Achilles tendonitis includes patient history, physical examination and sometimes imaging tests. Physical examination findings include palpation for tenderness, swelling, nodules, warmth, and increased width of the tendon. Imaging tests that may help diagnosis Achilles tendonitis include: x-ray, ultrasound, and MRI. Ultrasound is the most reliable in determining the thickness of the Achilles tendon and is most convenient as it can be performed during the patient encounter.
Here is a picture of an Achilles tendon in longitudinal axis with Ultrasound:
Non Surgical Achilles Tendonitis Treatment Options
The most effective treatment, and first line treatment, is still the R.I.C.E. regimen along with oral NSAIDs if the patient can tolerate them without significant GI upset. This regimen should be used immediately after an injury and has shown to reduce recovery time. NSAIDS should be dosed appropriately for the best anti-inflammatory effects
Formal physical therapy is often needed. Regaining flexibility, strength, power, muscular endurance, balance and coordination will be the primary role in the rehabilitation of the injury. The major points in rehab for Achilles tendonitis are to improve the elasticity of the calf muscle and increase pain free range of motion of the ankle.
Walking boots can be used in initially to limit the motion of the Achilles in severe cases, and allow healing. However there should be periods of time out of the boot to allow for range of motion exercises, otherwise the ankle will get very stiff in a short amount of time.
Nitro Patches are sometimes used in the treatment of chronic Achilles tendon problems. The mechanism of action is suggested to be through the metabolite nitric oxide. The patches have a local vasodilatory effect and increase blood flow to the injured tendon which is thought to aid in the healing process. The side-effects of topical nitro patches include headache and hypotension. The dose usually requires the cutting of a patch into a quarter of the packaged product.
Corticosteroids have anti-inflammatory properties and are widely used in musculoskeletal medicine. In weightbearing tendons, such as the Achilles or patellar tendon, there is a risk of tendon rupture after corticosteroid injections. This may be due to a temporary weakening of the tendon. The risk is thought to be higher if the injection is into the tendon itself, which creates distension and pressure in already degenerated tissue. These injections are best performed under ultrasound guidance to minimize the risk of incorrect placement of the injection into the tendon itself.
Prolotherapy, or “proliferation therapy”, is a term that is generally used to describe various injections which act to strengthen weakened degenerative connective tissue by an irritant effect. They are mostly used at insertions of tendons or ligaments. The types of solutions vary but commonly used injection types include glucose, local anesthetics such as lidocaine, phenol, or glycerine. The evidence for prolotherapy is fairly mixed, but some patients do tend to see improvement, particularly in chronic cases.
The evidence for the use of autologous blood products, including platelet rich plasma (PRP), to treat Achilles tendinopathy or other tendinopathies is mixed. Some patients do very well, and some do not respond. These injections , like prolotherapy, are probably best used for cases of chronic and severe insertional Achilles tendinopathy.
8. Surgery is generally reserved for recurrent cases where non-surgical management has failed to provide effective relief or the ability to function in daily life or in sporting activities. It is usually dictated by the patient who may become frustrated by continued symptoms despite long periods of exercise rehabilitation and also trials of injections and other therapies.
Schedule an Appointment for Achilles Tendonitis Treatment in Raleigh, NC
Don’t wait! Call us at (919)719-2270 today to experience knee pain relief without the risk of surgery.