Insertional Achilles Tendinopathy

  What is insertional Achilles tendinopathy?

Insertional Achilles tendinopathy affects the part of the Achilles tendon where it attaches to the back of the heel bone.

The tendon may become thickened and painful. Bone spurs or calcium deposits can also develop.

What symptoms and signs might I experience?

• Pain at the back of the heel.
• Morning stiffness.
• Pain after periods of rest.
• Swelling or thickening of the tendon.
• Pain from shoes rubbing the heel.
• Pain walking uphill or climbing stairs.
• Pain during exercise.
• Reduced calf strength.

How is it diagnosed?

Diagnosis is usually based on your symptoms and examination.

Ultrasound or MRI may be used to assess the tendon if the diagnosis is uncertain or surgery is being considered.

X-rays can show associated bone spurs or calcium deposits.

How is it treated without surgery?

Treatment may include:

• Temporary reduction in aggravating activities.
• Structured calf-strengthening exercises,  not stretching.
• Physiotherapy.
• Appropriate footwear.
• Heel lifts.
• Pain relief.
• Shockwave therapy in selected cases.
• Avoiding prolonged compression of the Achilles tendon.

Exercise programmes for insertional Achilles problems are often modified compared with those used for mid-portion Achilles tendinopathy. These injuries require eccentric loading and avoidance of stretching.

When might surgery be considered?

Surgery may be considered when significant symptoms persist despite an appropriate rehabilitation programme.

What might surgery involve?

Depending on the problem, surgery may include:

• Removal of damaged tendon tissue.
• Removal of calcium deposits.
• Removal of a prominent area of the heel bone.
• Treatment of an associated bursa.
• Achilles tendon repair or reattachment.
• Tendon augmentation or transfer if significant   tendon tissue is damaged.

What is recovery like?

The Achilles tendon needs time to heal following surgery. Recovery commonly involves an initial period of protection followed by gradually increasing movement and strengthening. A 12 month recovery is average.

Return to higher-impact activities can take upto a year.