The treatment of Achilles tendonitis and the bone spurs that irritate it involve simultaneously restricting the tendon’s motion through support and increasing its flexibility passively through stretching. By reducing its motion with a specialized ankle brace, the Achilles tendon can be supported and daily activities can continue with minimal harm to the injured tendon. Another variation of this for milder cases involves using a special heel lift that increases the slack on the Achilles tendon, leading to decreased strain when walking. Stretching exercises done passively, without the full weight of the body forcing the ankle upward, increase the ‘looseness’ of the tendon, making it less prone to strain and continued injury. It is vital that these are performed several times a day.
Inflammation is treated with anti-inflammatory medications and icing. Unlike other causes of heel pain, injections are not used near the Achilles tendon as the medication can weaken the tendon and cause it to rupture.
Physical therapy is also used to stimulate the healing process and to strengthen the tendon fibers. This is sometimes necessary in cases of chronic tendonitis, or acute injuries that do not respond to initial treatment.
For spurs and Haglund’s deformities, shoe modification may be needed to reduce the irritation the back of the shoe has on the heel. Prescription orthotic inserts are also used to control heel rotation, and can be of value to prevent Achilles tendonitis from returning in treated cases where flat feet cause over-rotation of the heel bone and strain the tendon attachment point.
Finally, surgery is needed when patients do not improve with the above measures. See the section on surgery for more information on the specific surgical technique.