Non-Surgical Treatment Options
Conservative non-surgical treatment remains effective in the majority of patients with liberal use of nonsteroidal anti-inflammatory drugs, heel lifts, stretching and shoes, which do not provide pressure over this area. If symptoms persist, then night splints, arch supports and physical therapy may be of benefit. If this fails, then application of a cast or brace with gradual return to activity is indicated. Nitroglycerin patches may also be of benefit in an attempt to increase the blood supply to this area.
Surgical Treatment Options
Surgical treatment is indicated if there is failure of several months of nonsurgical treatment. Surgery removes the degenerative portions of the tendon, any bone which is irritating the tendon as well as any inflamed bursa tissue. If the tendon is short, then lengthening may also be necessary. The tendon attachment to the heel bone may need to be strengthened with sutures which attach directly into the bone.
Several different approaches and techniques including endoscopy are used to achieve these goals without a clear consensus regarding which is best in terms of both success as well as complications. In older patients or those in whom more than 50% of the tendon is removed, then one of the other tendons at the back of the ankle is usually transferred to the heel bone to assist the Achilles Tendon, with strength as well as provide a better blood supply to this area.