Insertional Achilles Tendonitis: Symptoms, Causes, Treatments

The strongest tendon in our bodies, the Achilles tendon, is also one of the most susceptible to injury. Because it bears an extraordinary amount of weight when we walk, run, jump, and land, the Achilles gets put under immense strain.

Athletes in particular struggle with Achilles injuries, particularly those that participate in basketball and in track and field events. Overuse can cause inflammation, and if it's particularly bad, one sharp movement can cause the Achilles tendon to rupture or tear, leaving the individual in extreme pain. 

One of the precursors to an Achilles tear is inflammation at the point where the Achilles tendon attaches to the heel bone. This is known as insertional Achilles tendonitis. Here is a rundown of the symptoms, causes, and treatments for insertional Achilles tendonitis:

Symptoms

The primary symptom is a gradual onset of pain and tenderness at the back of the heel, along the Achilles tendon. The pain will come on slowly over time, getting worse the longer it goes untreated. Activities that require short bursts of explosive movements, like sprinting or jumping, will cause the most severe pain. The tendon will feel painful at any time the ankle is bent upwards below a 90-degree angle with the shin. 

Causes

The cause of insertional Achilles tendonitis is typically going to be a degeneration of the tendon over time. It comes from heavy usage of the calf muscles, where the tendon attaches at the top and the foot and ankle joints at the bottom. 

Patients who can be predisposed to a higher likelihood of the injury include those with conditions such as Reiter's syndrome, spondyloarthropathy, gout, familial hyperlipidemia, sarcoidosis, and those who are using drugs such as steroids or fluoroquinolone antibiotics. 

Diagnosis

Your doctor, who should be a foot and ankle specialist, will perform a clinical exam of your ankle and your Achilles tendon, before determining if there should be an x-ray. On the x-ray, the doctor will look for bone deposits at the insertion point of the tendon and the heel. He/she may also order an MRI to examine the Achilles for potential tears or other conditions like bursitis. 

Treatment

There are two primary treatment options: surgical and non-surgical. The ideal option is to go non-surgical and rehabilitate the tendon and the muscles surrounding it to become strong once again. 

Non-surgical treatment

  • The doctor will recommend anti-inflammatory drugs, such as ibuprofen, to treat the inflammation.
  • The doctor will recommend stretching the calf and the ankle surrounding the damaged tendon.
  • The doctor will recommend heel raises to strengthen the tendon.
  • The doctor will recommend changing to a new pair of shoes or getting orthotics.

Surgical treatment

  • If non-surgical treatment is unsuccessful after several months, then the doctor will look to perform surgery.
  • During surgery, the doctor will generally remove the damaged part of the tendon, as well as part of the bone on the heel to create a healthy spot for the tendon to reattach. He/she will then reattach the tendon. 
  • Next, the doctor will place the patient in a walking boot for 6-12 weeks before beginning physical therapy. 
  • The entire recovery process post-op will take between 6-12 months. 

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