Treatment Overview

Treatment for Achilles tendinopathy includes not only rest to allow the tendon to heal but also ways to increase strength and flexibility to prevent further injury. Treatment for an Achilles tendon rupture includes surgery or a cast, splint, brace, walking boot, or other device that will keep your lower leg from moving (immobilization). Early treatment usually results in better healing.

Achilles tendinopathy

To treat Achilles tendinopathy, your doctor will advise you to:

• Rest the lower leg and foot, avoiding any hard or intense activity for 6 to 12 weeks and until symptoms go away.
• Switch or modify sports or other activities that may have caused the tendinopathy.
• Wear well-cushioned shoes, heel pads, or other orthotics if they help relieve pain.
• Reduce pain by using ice or taking over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), as directed. An example of acetaminophen is Tylenol. NSAIDS include ibuprofen (Advil, Motrin) and aspirin. Do not give aspirin to anyone younger than 20 because of the risk of Reye syndrome.
• Gently stretch the Achilles tendon area and do general stretches each day and before running or other strenuous activity.
• Follow any physical therapy that your doctor has prescribed, including stretching and strengthening exercises, massage, heat, or ultrasound.

Your doctor may suggest that you wear a night brace to keep your foot flexed, if your Achilles tendon shortens and stiffens while you sleep.

If you continue to have pain or stiffness in the ankle area, your doctor may prescribe a walking boot or other device for 4 to 6 weeks to keep your lower leg and foot from moving and allow the tendon to heal.

If you still have Achilles tendon pain after more than 6 months of consistent treatment and rest, you might need to consider surgery.

Achilles tendon rupture

Treatment for an Achilles tendon rupture includes:

• Surgery followed by rehabilitation (rehab). This is the most common treatment. It reattaches the torn ends of the tendon and can be done through one large incision (open surgery) or several smaller incisions (percutaneous).
• Immobilizing your leg followed by rehab. This prevents movement of the lower leg and ankle and allows the ends of the Achilles tendon to reattach and heal. A cast, splint, brace, walking boot, or other device may be used to do this.

What To Think About

Do not smoke or use other tobacco products. Smoking slows healing because it decreases blood supply and delays tissue repair.

If you have an Achilles tendon rupture, your decision about whether to have surgery will depend in part on your:

• Attitude toward reinjury and complications. Immobilization using a cast or similar device is more likely than surgery to result in another rupture but is less likely to result in complications, such as wound infection.³
• Level of activity. If you are very active in sports or have a job that requires leg strength and you want your leg to be as strong as it was before your injury, you may consider surgery.
• Age. If you are an older adult who does not do activities that may result in another rupture and who does not want the added risk of surgery, you may prefer using a cast or similar device.
• Medical condition. If you have another medical condition—such as diabetes or heart or lung disease—that raises the risks associated with surgery, you may prefer using a cast or similar device.
• Time of injury. Surgery is generally recommended if the rupture is more than 2 weeks old.

Achilles Tendon Rupture: Should I Have Surgery?