Achilles Tendinitis: Conservative Treatments, Injections, and PRP
Published on 2026-05-21
Achilles Tendinopathy: From Diagnosis to Personalized Treatment
Achilles tendinitis (or Achilles tendinopathy) is a common condition, especially in runners and athletes who practice jumping sports. The Achilles tendon, the strongest tendon in the human body, withstands forces equivalent to 6 to 8 times body weight during running. Its intense demand makes it vulnerable to overuse injuries.
The Two Forms of Achilles Tendinopathy
Non-insertional tendinopathy (mid-portion): affects the middle part of the tendon, 2 to 6 cm from its calcaneal insertion. More common in runners. Associated with degeneration of the tendon body.
Insertional tendinopathy: affects the tendon insertion on the calcaneus. May be associated with retrocalcaneal bursitis. More common in less active people and related to biomechanical factors.
Symptoms
- Pain on palpation of the Achilles tendon
- Morning stiffness of the tendon
- Pain at the beginning of activity that subsides and then returns after exercise
- Palpable tendon thickening (degenerative nodule)
- Difficulty standing on tiptoes (sign of tendon weakness)
Conservative Treatment (First Line)
- Eccentric exercises: the gold standard treatment. The Alfredson protocol (daily eccentric calf exercises) shows success rates of 60 to 80% at 12 weeks.
- Relative rest: activity modification without complete cessation
- Ice: after activities, 15 minutes of local application
- Appropriate footwear: avoid flat shoes, small heel to relieve the tendon
- Physiotherapy: massage, stretching, and neuromuscular re-education complete the rehabilitation program
Advanced Treatments
When conservative treatment is insufficient after 3 to 6 months, several advanced options exist:
- PRP (Platelet-Rich Plasma): ultrasound-guided injection of growth factors to stimulate tendon healing. Recent studies show significant efficacy for chronic Achilles tendinopathy.
- Extracorporeal Shock Wave Therapy (ESWT): effective for both insertional and non-insertional tendinopathy, especially when calcifications are present.
- Ultrasound-guided fenestration: multiple needle punctures to stimulate healing in the degenerative area.
- Surgery: reserved for cases refractory to all conservative and interventional treatments after 6 to 12 months.
Frequently Asked Questions
What is the difference between Achilles tendinitis and tendinopathy?
Tendinitis is an acute inflammation of the tendon, whereas tendinopathy is a chronic degenerative process without significant inflammation. Most "Achilles tendinitis" cases are actually tendinopathies, which explains why anti-inflammatories are often ineffective in the long term.
Are eccentric exercises really effective for Achilles tendinitis?
Yes, these are the most effective exercises. Randomized studies show a success rate of 60 to 80% after 12 weeks of daily eccentric protocol. The key exercise is slowly lowering the heel under load from a tiptoe position.
Is PRP effective for the Achilles tendon?
Yes, recent studies show that ultrasound-guided PRP is significantly more effective than placebo for chronic Achilles tendinopathy. Efficacy is maximized when the injection is precisely delivered to the degenerative area, hence the importance of ultrasound guidance.
Can I run with Achilles tendinitis?
No, running is not recommended in the acute phase. After treatment, return is gradual (brisk walking, light running on flat ground, then intervals). Return to normal running typically takes 4 to 12 weeks depending on initial severity.
What are the signs of an Achilles tendon rupture?
A rupture manifests as sudden and intense pain (feeling of being kicked or torn), inability to stand on tiptoes, a palpable gap at the rupture site, and a positive Thompson test (absence of plantar flexion when squeezing the calf). This is a medical emergency.