Achilles Tendonitis Treatment in Singapore

Achilles tendonitis is an overuse injury causing pain and swelling in the Achilles tendon, the body’s largest tendon that connects the calf muscles to the heel bone. It is essential for running, jumping, and standing on your tiptoes. Athletes frequently experience this condition due to repetitive strain, but it can also arise from regular wear and tear over time.

The condition is categorised into two types: non-insertional, affecting the midsection of the tendon, and insertional, impacting the lower part where the tendon attaches to the heel bone. Both types result from overuse, leading to the tendon’s inflammation and degeneration.

Fortunately, Achilles tendonitis is less severe than an Achilles tendon tear, and there are several ways to manage it:

Home Remedies:

• Rest
• Ice packs to reduce swelling
• Heat pads to relax muscles and improve blood flow
• Over-the-counter pain medication (NSAIDs)
• Light stretching exercises

Non-Surgical Treatments:

• Specialist-recommended orthotic devices (shoe inserts, wedges)
• Physical therapy (eccentric Achilles stretching and strengthening)

Minimally Invasive Procedures:

• Platelet-rich plasma (PRP) injections
• Arthroscopic debridement (removing damaged tissue and bone spurs)

When you’re experiencing any of these symptoms, you could have Achilles tendonitis and may require specialist treatment from an orthopaedic surgeon in Singapore:

• Pain and stiffness in your Achilles tendon in the morning
• Pain in the Achilles tendon when it is moved or touched
• Pain in your heel and the length of the tendon when running or walking
• Difficulty standing on one toe
• Warmth and inflammation in the heel or along the tendon
• Reduced range of motion that manifests as difficulty in bending an ankle or pointing a foot

Noticeable bump or a feeling of thickness on the Achilles tendon

Achilles tendonitis stems from repetitive stress on the tendon, often due to a sudden increase in physical activity without adequate conditioning. Tight calf muscles can impose additional strain on the tendon at its heel bone insertion point. Haglund’s deformity, an enlargement of the heel bone, may also irritate and inflame the tendon. If you’re encountering these risk factors or experiencing symptoms of Achilles tendonitis, seeking medical assistance promptly in Singapore is advised to receive timely specialist treatment and avert more serious injuries.

Diagnosing Achilles tendonitis begins with a detailed review of your medical history and a physical examination. An orthopaedic specialist will inquire about your athletic activities, symptoms, and any past treatments. During the physical exam, the specialist may observe your walk to assess gait abnormalities and palpate the tendon for swelling or irregularities. Your calf muscles, which connect to the Achilles tendon, will also be evaluated.

For a more in-depth analysis, imaging tests such as X-rays or MRI scans may be performed. These tests provide a clear image of the Achilles tendon structure and help to exclude other potential causes of pain, such as bone fractures.

For those experiencing Achilles tendonitis, specialists recommend an initial approach of Rest, Ice, Compression, and Elevation (RICE). Also, it is crucial to pause exercise or any activities that might aggravate the condition for several days. To manage pain and swelling, apply an ice pack to the affected area. Wraps or compressive elastic bandages can also be effective in reducing swelling. Moreover, elevating the foot above heart level, particularly while sleeping, can aid in decreasing inflammation. Following these steps can offer significant relief and prevent further strain on the Achilles tendon.

The treatment for Achilles tendonitis varies according to the severity of the tendon condition. The orthopaedic specialist may suggest conservative treatments or other therapies to facilitate healing. Here’s a breakdown:

Tailored exercise programmes will be provided by a specialist to strengthen the Achilles tendon and its supporting structures. Special devices such as orthotics, which correct foot alignment, or walking boots, which lessen tendon load, may be recommended, especially for more serious injuries.

For persistent pain and inflammation unresponsive to conservative measures, EMTT offers a non-invasive solution using magnetic pulses. An Achilles tendonitis specialist may recommend sessions that last about 5-10 minutes over 6-8 appointments, depending on the condition’s severity.

Another non-surgical option, ESWT, applies shock waves to the injured tissue to alleviate pain and encourage healing, usually in under 30 minutes per treatment. It’s an option that Achilles tendonitis specialists suggest when traditional methods haven’t provided relief.

Surgery is considered by specialists when non-surgical approaches fail to improve the condition, particularly for severe cases involving tears in the Achilles tendon and muscle.

Preventing Achilles tendonitis involves understanding your body’s limits and taking these proactive steps to protect your tendons:

• Gradual Increase in Activity: Avoid sudden increases in exercise intensity, and gradually increase your workout duration and intensity to allow your tendons to adapt.
• Warm-up and Cool-down: Always warm up with dynamic stretches before a workout and cool down with gentle stretches afterwards to enhance flexibility and blood flow.
• Proper Footwear: An orthopaedic specialist may recommend wearing supportive shoes with enough cushioning for your arches and heels. Also, replace worn-out shoes regularly to maintain support.
• Strengthen and Stretch: Strengthen your calf muscles with exercises like heel raises and toe curls. You can also improve ankle flexibility with regular stretching.
• Listen to Your Body: Pay attention to pain signals and rest when needed. Additionally, don’t push yourself beyond your limits, especially when starting a new activity.
• Vary Your Workouts: Alternate high-impact sports with lower-impact options to reduce repetitive stress on your Achilles tendon.
• Maintain a Healthy Weight: Maintain a healthy weight to reduce the strain on your joints and tendons, including the Achilles tendon.

The recovery time for Achilles tendonitis varies, often depending on the severity of the condition and the treatment approach used by the specialist. For non-surgical treatment, patients may start to see improvement within a few weeks. However, complete recovery could take several months, especially if the tendonitis is more severe.

Patients undergoing surgery generally face a longer recovery period, and post-operative healing can range from 10 months to over a year. During the recovery process, you can generally expect the following:

Immediately After Surgery (Week 0-2):

• Expect pain, swelling, and bruising around the surgical site.
• You’ll likely wear a cast or splint to immobilise your foot.
• Keep your foot elevated to reduce swelling.
• Mobility will be limited, and you might need crutches.

First Few Weeks After Surgery (Week 2-6):

• Gradually transition to a walking boot.
• Physical therapy may begin with gentle range-of-motion exercises.
• Continue using crutches or a walking aid.
• Avoid weight-bearing activities.

First Few Months After Surgery (Week 6-12):

• Gradually increase weight-bearing as tolerated.
• Progress to more advanced physical therapy, including strengthening and flexibility exercises.
• Transition from the walking boot to supportive footwear.

Several Months After Surgery (3-6 months):

• Continue physical therapy to regain full strength and flexibility.
• Gradually return to normal activities and low-impact sports.
• Wear supportive footwear and use orthotics if needed.

6 Months and Onwards After Surgery:

• You may be able to return to high-impact activities, depending on your progress and your surgeon’s advice.
• Continue strengthening and flexibility exercises to maintain tendon health and prevent re-injury.

If you’re experiencing persistent pain, stiffness, or swelling in your Achilles tendon, you might be a candidate for Achilles tendonitis treatment. Also, note that individuals who are particularly susceptible to this condition include athletes, people with flat feet, older adults, and those who recently increased their activity levels.

If you think you might have Achilles tendonitis, don’t hesitate to schedule a consultation with our orthopaedic specialists at Mount Alvernia Hospital or Mount Elizabeth Novena Hospital. Aside from diagnosing your condition, we can recommend the most appropriate treatment plan to help you regain your mobility.

Dr. Gowreeson Thevendran is a fellowship-trained orthopaedic surgeon specialising in minimally invasive treatments for ankle injuries, including sprains. He also focuses on the importance of accurate diagnosis and personalised treatment to achieve optimal recovery and prevent long-term complications. With his training from the UK to Canada, he is experienced in both the operating room and global orthopaedic education.

Dr. Gowreeson Thevendran is currently an orthopaedic surgeon with Island Orthopaedic, a one-stop care centre for orthopaedic health under Healthway Medical Group. He specialises in treating lower limb orthopaedic conditions, as well as trauma and fracture surgery of both the upper and lower limbs. Prior to establishing his private practice, Dr Gowreeson was Chief of Foot & Ankle Surgery at the Department of Orthopaedics at Tan Tock Seng Hospital (TTSH). Today, he continues to serve the Orthopaedic Department at TTSH as a visiting consultant.

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