The proper Achilles tendon treatment depends on the complaint and a professional diagnosis. 80% of treatment success depends on a correct diagnosis!

The following list of treatment approaches is not exhaustive. If you are struggling, please see a doctor or physiotherapist. They may be able to offer other successful forms of treatment.

 

Selecting a suitable form of treatment is based on:

1. Achilles tendon treatment according to location or diagnosis of symptoms.
2. The healing process and its different healing phases.
3. Other causes leading to Achilles tendon pain (causal treatment).

1. The healing phases of a damaged Achilles tendon

Acute phase -> 1 day to 1 week

• = acute inflammation phase: repair of blood vessels in the event of tears; breakdown of damaged tissue; immune defense kicks in
• this occurs immediately after a complete or partial Achilles tendon tear, as well as in the case of inflammation of the bursa and gliding tissue of the tendon
• in the ensuing inflammation phase the tissue starts to rebuild

Proliferation phase -> 3 days to approx. 6 weeks

• the inflammation continues to go down. After 14 days it has normally subsided
• formation of new, 'medium-quality' tissue (type III collagen)

Remodeling phase -> 1 week to approx. 1 year

• transformation of 'medium-quality' tissue into high-quality tissue (type I collagen)
• increased resilience and elasticity
• from approx. the 4th to the 5th month*, full-weight-bearing exercise may be resumed

*Please note: a return to full weight bearing activity within the scope of Achilles tendon treatment is difficult to define as it depends on:

 

o             the surgeon and their operating technique

o             the healing process, which differs from one person to the next and also depends on the methods used

o             the type of exercise. In the case of sporting activities with predominantly cyclical movements, such as jogging, the process is faster (the above-mentioned four to five months); in the case of sports involving high loads, such as jumping and all sports with rapid changes of direction and sudden stops and acceleration, it normally takes longer.

So, please discuss with your therapist when it will be possible to resume activity!

2. Achilles tendon treatment according to location or diagnosis of symptoms

a. Achilles tendon tear

The terms Achilles tendon tear and Achilles tendon rupture are often used synonymously on the Internet, however, not by experts. We always take an Achilles tendon tear to be a complete tear – or Achilles tendon rupture in medical jargon – and use the term partial Achilles tendon tear separately.

Most Achilles tendon tears occur 2–6 cm above the point where the Achilles tendon starts on the heel bone.

• Conservative treatment of partial Achilles tendon tears. No surgery is performed. Both ends of the tendon at the point of the tear must be brought as close together as possible by maintaining the foot in the equines position during the initial healing phase. This can be done using a special shoe.
• Complete Achilles tendon tear surgery (partial tears can also be fixed by surgery). This is either carried out using the 'mini-open technique' (small cut in the skin), or the open technique with a longer cut in the skin.
• Further treatment depends on the healing phases and which operating method is decided upon.

b. Tendinopathy

• This involves the degeneration of the Achilles tendon, whereby the already started healing phase has not passed the remodeling phase. For this reason, it is very important to resume the healing process with enough stimulation/load; the load must be adapted to the current healing phase. This is mainly done through movement and stretching or weight bearing. Other measures may be useful (see ‘Forms of treatment’):

  • shockwave therapy
  • ultrasound therapy
  • laser therapy
  • physiotherapy (myofascial release, trigger point therapy, stretching exercises, massage, friction massage)
  • taping (also medical flossing)
  • pain relief patches
  • acupuncture and acupressure
  
  
  

Home measures:

• eccentric strength training (only to a foot position of 0°, that is, only to the floor in the case of tendiopathies at the base of the Achilles tendon in the first few weeks)
• wearing FALKE Achilles socks
• massage with a toothbrush
• exercise with a foam roller

c. Achillobursitis, bursitis and peritendinitis

In the acute phase:

• pain relief patches
• injections
• cooling
• heel elevation
• anti-inflammatory measures (massage)

In the proliferation phase:

• physiotherapy (myofascial release, trigger point therapy, stretching exercises, massage)
• shockwave therapy
• ultrasound therapy
• laser therapy
• taping
• acupuncture and acupressure
• home measures:
• eccentric strength training (floor level training) on the floor, not on a step; lowering the injured leg to a position of 0°, only to the floor
• wearing FALKE Achilles socks

In the remodeling phase:

• shockwave therapy
• ultrasound therapy
• laser therapy
• physiotherapy (myofascial release, trigger point therapy, stretching exercises, massage, friction massage)
• taping (also medical flossing)
• acupuncture and acupressure
• pain relief patches

Home measures:

• eccentric strength training (to below 0° = on step to below the edge of the step)
• wearing FALKE Achilles socks
• massage with a toothbrush
• foam roller

3. Causal treatment – in the case of other causes of Achilles tendon pain

Alongside different measures at the site where the symptoms have appeared, it is of vital importance to get to the root of the actual causes of the symptoms and to remedy them.

Treatment of other physical causes (also see 'Achilles tendon pain'):

• physiotherapy to strengthen and stretch the calf muscles and rear thigh muscles
• myofascial therapy along the corresponding chains
• sensorimotor and coordination training
• possible change of diet
• training motor skills for the corresponding sport

Change in external causes (also see 'Achilles tendon pain'):

• custom-made insoles and trainers
• adapted training plan

 

The future of Achilles tendon treatment:

Other forms of treatment are being developed and tested, including therapeutic approaches with growth factors, which are supposed to support tendon healing. However, this approach is still in its infancy and is the subject of controversial debate among experts.