Insertional Achilles Tendinitis

Insertional Achilles Tendinitis

Achilles tendinitis is a common cause of posterior heel pain. Patients who have this often also have had plantar fasciitis in the past. This is because the cause is similar. Fortunately, many cases are able to be treated without surgery.

The Achilles tendon is the largest tendon in the body. Tendinitis is inflammation of this tendon, which can be caused by overuse, shoe rubbing, inflammatory disorders, a particular shape of the heel bone, and tight calf muscles. The body responds to micro-tears in the tendon by laying down calcium deposits, which are commonly called “bone spurs.” The calcium is not the painful portion of the disease, but is a helpful sign on x-ray to signify chronic injury to the tendon

Treatment

Nonsurgical Treatment

Insertional Achilles tendinitis can be persistent. Nonoperative treatment may take nine months to a year to be effective. However, many patients do improve and never go on to need surgery.

Stretching

Calf: Stand about three feet from a wall or counter. Turn the symptomatic foot inward slightly, then step forward with the opposite foot towards the wall, and lean against the wall. Focus on keeping the back knee straight and the heel against the ground, while the front knee bends. Keep your torso in line with the back leg. You should feel the stretch high on the calf, towards the inside. Do not bounce. Hold this stretch for several minutes. In order to effectively stretch this muscle when tight, you should aim for about twenty minutes of stretching a day, though you can divide this into small increments at your convenience. Stretch both sides to prevent injury on the other side.

Anti-inflammatories

NSAIDs should be taken around the clock for two to three weeks for antiinflammatory dosing. Speak to your physician if you have concerns about whether anti-inflammatories are safe for you.

Heel cup/lift

You may have already found that boots or shoes with a slight heel are more comfortable. This is because it takes a little tension off the tight calf muscle, and therefore off the Achilles tendon. Adding a silicone heel cup with a slight lift in your dress shoes and tennis shoes can make activity more comfortable until your calf becomes less tight.

Ice

Only use ice if you have no numbness in your feet. If you have any neuropathy, ice application may not be safe. Wrap the ice pack with a dry washcloth to protect your skin. Ice for up to twenty minutes at a time, and be sure to wait an hour if you are going to repeat the ice application.

Physical Therapy

Physical therapy is commonly prescribed for Achilles tendinitis. The supervision and modalities that therapists are able to offer patients make it more effective than simple home stretching routines.

What not to do

Do not get cortisone injections into the Achilles tendon, because it will increase the risk of rupture of the tendon.

Surgical Treatment

Surgery for insertional Achilles tendinitis is only done after the pain persists despite a prolonged course of nonoperative treatment. In most cases, the surgery requires complete detachment of the Achilles tendon, removal of the bony prominence, and reattachment of the tendon. For the tendon to heal back to the bone, the foot has to be immobilized in a cast for 6 weeks with the toes pointed downwards, generally without being able to walk on it. The foot is gradually brought to a neutral position and physical therapy is started after the cast is removed. Physical therapy is crucial to the recovery after surgery. The most serious risk in this surgery is infection of the wound or detachment of the tendon; both of these are attributed to the poor blood supply to this region. For this reason, surgical candidates should minimize their risk of such complications by smoking cessation, weight loss, and good compliance with post-operative protocols.

Summary of treatment of Insertional Achilles Tendinitis

  • Calf stretches
  • Anti-inflammatories
  • Silicone heel lift
  • Ice
  • Physical Therapy
  • Surgery, only when all else fails