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July 13, 2021

When to see a doctor about Achilles tendon pain

Latest research questions the effectiveness of PRP injections

Adult Health Pain Relief
Achilles tendon pain Anne Nygard/Unsplash

Platelet-rich plasma injections are a popular form of regenerative medicine that some people with Achilles tendon pain turn to for pain relief, however, the latest research suggests that these injections don't provide any real benefit to the patient.

The Achilles tendon, which connects the calf and lower leg muscles to the heel bone of the foot, is the largest tendon in the body.

Acute injury to the tendon or overuse can lead to tenderness and pain when walking or running or bending the foot. The two most common causes of Achilles tendon pain are Achilles tendonitis and Achilles tendinosis.

Platelet-rich plasma injections are a popular form of regenerative medicine that some people with Achilles tendon pain turn to for pain relief. However, the latest research suggests that these injections don't provide any real benefit to the patient.

Achilles tendonitis is an acute, inflammatory condition that most commonly affects athletes, especially runners. The pain is often described, according to Verywellhealth, as a burning sensation along the tendon or near the heel bone. It tends to worsen with activity. Many patients also experience mild swelling and morning stiffness.

Achilles tendinosis is an overuse injury caused by a chronic, degenerating tendon. Most often it is the result of untreated tendonitis, so early diagnosis is important.

The most severe Achilles tendon injury is a rupture where the tendon is torn. The patient may hear a popping noise accompanied by severe heel pain.

If you are experiencing any stiffness or tenderness in your legs or ankles or any signs of swelling or infection, you should get evaluated by a doctor. Any severe pain indicating a possible rupture should receive immediate medical attention.

The most common treatment for Achilles tendonitis is rest or reduction of activity. Physical therapy including gentle stretching and strengthening exercises is usually prescribed. If your condition progresses to tendinosis, you will need a more specialized rehabilitation program. Ice during the initial onset of pain and after exercise can also be helpful.

An Achilles tendon rupture sometimes requires surgical repair. A partial tendon rupture, however, is often treated more conservatively with immobilization and physical therapy.

Some patients also try platelet-rich plasma injections to accelerate recovery, according to the Hospital for Special Surgery.

Platelet-rich plasma injections are a form of regenerative medicine or self-healing that has become popular in recent years. Basically, a patient's own platelet-rich plasma is injected into an injured tendon or ligament such as the Achilles tendon to improve healing and reduce pain.

Previous studies have shown that this type of treatment can be effective in healing soft tissue and bone, particular in chronic conditions including tennis elbow, rotator cuff tears and Achilles tendinosis.

Still, researchers say that more clinical studies are needed to weigh the benefits versus the risks of this type of treatment. One recent study contradicts previous findings that PRP injections can effectively treat Achilles tendinopathy.

The researchers found no actual benefit for these patients and recommend that the treatment no longer be used for them. In their study, published in the Journal of the American Medical Association, they randomly assigned 240 patients with Achilles tendinopathy to either receive PRP treatment or a sham injection.

The patients were then asked to complete a self-assessment of their pain, function and activity three months and six months after the injection. Overall, there were no statistical differences in the average scores of each groups, the researchers found.

"The only reason for treating tendinopathy is if the patient is experiencing pain, as the condition doesn't cause pain in all cases. What's important to patients is they want a reduction in pain, to be able to do the activities they could before. We set what was a clinically important difference and that wasn't met in the trial," said Rebecca Kearney, lead author and professor at the University of Warwick.

"Achilles tendinopathy can cause significant pain and prevent people from staying active. The results from this study suggest that platelet-rich plasma injections do not improve pain or function, and therefore shouldn't be recommended as a treatment for this condition. More research is needed to ensure we find effective treatments for people who have persistent painful Achilles tendinopathy," added Caroline Aylott, head of research delivery at Versus Arthritis, the funders of the research.

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