Steroid tablets for Achilles tendinopathy – Why it’s not a good idea

Steroid tablets are still regularly prescribed for Achilles tendon pain, despite the research showing that it can be harmful. This article explains what the research has found about the effect of corticosteroids on your tendons, why it can delay your recovery from Achilles tendinopathy, why doctors still prescribe them, and also what to do if you've been using them and want to stop. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

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The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. Why steroid tablets are bad for your Achilles tendons

2. So, why do doctors still prescribe it?

3. How to wean yourself off steroid tablets for your Achilles injury

4. How we can help

We’ve also made a video about this:

Why steroid tablets are bad for your Achilles tendons

Let’s start with steroid injections. It has already been known for quite some time that steroid injections for Achilles injuries have detrimental effects on the Achilles tendon. In spite of this, it is still being prescribed, but fortunately not as often as before.

Our Achilles tendons are made up of collagen fibres arranged in parallel, with some cells in between – this is what makes tendons so strong. The collagen and cells get damaged or die after some time (like all other body tissue) and are replaced by new, healthy ones.

Benjamin Dean and his colleagues found, in a study published in 2014, that steroid injections have the following effects on tendons:

• They affect the parallel structure of the collagen fibres, which weakens the tendon.

• Steroid injections were found to increase the death rate of collagen and cells in tendons and to decrease the rate at which new ones are formed.

• They increase cellular toxicity, which, again, means that more tendon cells die or become damaged.

But what about steroids being taken as tablets or with an inhaler?

In a study published in 2015, Julia Spoendlin and her colleagues looked at 8,202 patients in the United Kingdom who had ruptured their Achilles tendon or biceps tendon. They compared these cases to a control group of 32,808 people who did not rupture their Achilles or biceps tendon.

People who took steroid tablets on an ongoing basis were three times more likely to have ruptured a tendon than those who did not use steroids. The risk or rupturing a tendon increased as the steroid dosage increased.

The heightened risk levels kicked in shortly after patients started taking the tablets and decreased shortly after they stopped taking them.

They also found that a single short-term high-dose (≥ 20 mg/day) steroid treatment course with tablets increased the risk of tendon rupture significantly.

However, the researchers found no such effects among the people who took steroids via inhalers.

In a more recent study (2020), Zilu Ge and colleagues studied tendon samples, at a cellular level, of people who had had surgery for ruptured Achilles tendons.

They found that those who had taken steroids tablets long-term before the surgery had weaker Achilles tendons than those who had not taken steroids. Also, the collagen fibres in the tendons of the steroid group were irregular and disordered.

They replicated this with rats (some were given steroids and others not) and got the same results.

One thing to note is that steroids taken in tablets obviously permeate through your whole body, putting all your tendons at risk, whereas an injection targets the injured tendon.

So, why do doctors still prescribe it?

If steroids, whether injected or taken as tablets, are so bad for you, why do doctors still prescribe it? It’s probably because it’s such an effective painkiller.

So, the patient is happy because they’re not in pain, but what are you doing to the healing process? You're not helping it at all. In fact, you might be delaying the healing process and making it harder for that tendon to respond to strength training later on.

Because remember, if you have an injured Achilles tendon, you will only regain full use of it if you do strength training exercises to get it back to where it was before you injured it. Rest alone won’t cut it – in fact, it may get even weaker in the long run.

How to wean yourself off steroids tablets for your Achilles injury

It is really important not to just suddenly stop taking your steroid tablets. You should slowly wean yourself off them over time. Here’s why.

Your body produces steroids by itself. When you take tablets to increase the steroid levels, your body goes, "Oh, there's plenty of that! I can detect it in the blood. So, I don't have to produce so much," and it decreases its steroid production.

So, if you go off the tablets cold turkey, it will be a pretty big shock to your body, and you may get really ill from that.

Rather speak to the doctor who prescribed the steroid tablets about a safe way of gradually coming off them.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References:

1. Dean, B. J. F., et al. (2014). "The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon." Seminars in Arthritis and Rheumatism 43(4): 570-576.

2. Spoendlin, J., et al. (2015). "Oral and inhaled glucocorticoid use and risk of Achilles or biceps tendon rupture: a population-based case-control study." Annals of Medicine 47(6): 492-498.

3. Ge, Z., et al. (2020). "Downregulation of type I collagen expression in the Achilles tendon by dexamethasone: a controlled laboratory study." Journal of Orthopaedic Surgery and Research 15(1): 70.