Best treatment for inflammed achilles tendonitis that has become acute for over 18 months?

Rest and Ice Therapy: Achilles tendonitis can be frustrating! rest, avoid aggravating activity, use aggressive ice therapy, gentle stretching and anti-inflammatory rx. Consider a podiatry visit / orthotics / even immobilization. Consider physical therapy and ultrasound. Lastly, note that certain medications can be harmful to the tendon such as quinolone antibiotics (eg: cipro) and steroids.

Achilles tendonitis: Persistent discomfort more than 6 weeks is consider chronic. In your case you may need physical therapy, x-ray or mri, maybe referral to ortho. We want to avoid rupture, and gradually improve your symptoms.

It Depends!: First, one has to differentiate between insertional and noninsertional achilles tendonitis, ie is the problem in the midsubstance of the tendon or where in attatches to the heel? The treatment is different depending on the type other than both need modification of activities to avoid overuse, heel lift, icing, anti-inflammatories and comfortable shoewear that doesn't rub the affected area. Ortho.