Non-Insertional Achilles Tendinopathy

What is non-insertional Achilles tendinopathy?

Non-insertional, or mid-portion, Achilles tendinopathy affects the middle part of the Achilles tendon, usually several centimetres above where it attaches to the heel.

What symptoms and signs might I experience?

• Pain in the middle of the Achilles tendon.
• Morning stiffness.
• Pain when starting exercise.
• Pain during or after activity.
• Thickening of the tendon.
• Tenderness.
• Reduced calf strength.
• Pain with heel raises or running.

How is it diagnosed?

Diagnosis is usually made clinically.

Ultrasound or MRI may occasionally be used to assess the extent of tendon damage or when symptoms are not responding as expected.

How is it treated without surgery?

The main treatment is progressive tendon loading and strengthening.

This may include:

• Calf strengthening.
• Eccentric exercises.
• Heavy slow resistance exercises.
• Gradual return to running or sport.
• Temporary modification of aggravating activities.
• Physiotherapy.
• Appropriate footwear.
• Shockwave therapy in selected patients.

Recovery can take several months and improvement is usually gradual.

When might surgery be considered?

Surgery is generally reserved for persistent symptoms despite an appropriate period of rehabilitation.

What might surgery involve?

Surgery may include removal of diseased tendon tissue and repair of the remaining tendon.

If there is extensive tendon damage, reconstruction or tendon transfer may be required.

What is recovery like?

Recovery following surgery is gradual. The tendon needs to heal before strengthening can progress, and return to running or sport can take several months.