Achilles Insertional Tendonitis

The Achilles tendon is the largest tendon in the body. It joins the calf muscles to the calcaneus (heel bone) and assists in walking, running, raising the heel and jumping. Insertional Achilles tendinitis involves the lower portion of the tendon where it attaches to the calcaneus bone.

Tendonitis can also occur higher up away from the attachment to the bone.
View non insertional Achilles tendonitis topic  

Insertional Tendonitis

Insertional Achilles tendinitis involves the lower portion of the tendon where it attaches to the calcaneus bone.

Symptoms of Insertional Tendonitis

Pain is often present with the associated inflammation. At the bony insertion site, a bump may develop called a Haglund’s deformity. This may become so large it can cause difficulty with fitting shoe wear, rubbing of the heel and even exquisite tenderness.

Imaging for Insertional Tendonitis

  • Weight-bearing X-rays are required
  • MRI scan may be required
Non operative treatment for Insertional Tendonitis

  • Topical anti-inflammatory creams
  • Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
  • Shoe wear modification e.g. open back shoes or heel lift
  • Orthotic with medial arch support to help any overpronation of the foot
  • Activity modification
    • improve fitness and strength via non axial loading exercises e.g. cycling or swimming. Avoid axial loading exercises e.g. running
    • avoid activities which overstretch the Achilles tendon
  • Physiotherapy
    • eccentric strengthening program
    • avoid aggressive stretching programs as these often exacerbate symptoms
  • Weight loss management
  • Extracorporeal shockwave therapy may be of benefit but this has not been proven
  • Corticosteroid injections must be avoided – there is a risk of tendon rupture
  • Eccentric strengthening
    • stand on the balls of your feet on the edge of a stair with legs straight
    • gently drop both heels down to below the level of the stair
    • hold for 10 seconds
Surgery for Insertional Tendonitis

Surgery is considered if symptoms are progressing and function is decreasing after a trial on non-surgical treatment.

Surgical options may include:

  • Open Achilles tendon debridement with removal of any calcific tissue and excision of the bony Haglunds deformity
    • An augment may be required e.g. FHL tendon
  • Reconstruction of the insertion of the Achilles tendon with anchors into the bone
Risks of Insertional Tendonitis surgery

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

  • Infection: superficial wounds or deep infections
  • Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
  • Nerve damage: tingling, numbness or burning
  • Ongoing pain
  • General or anaesthetic risks including to the heart and lung
  • Drug reactions/allergy
  • Scarring or tethering of the skin
  • Calf weakness
  • Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

Non-Insertional Achilles Tendonitis

Non-insertional Achilles tendonitis occurs 2-6cm higher up the leg from the insertion point in the main body of the tendon.

Symptoms of Non Insertional Tendonitis

  • Pain and stiffness along the Achilles tendon in the morning
  • Pain along the tendon or back of the heel that worsens with activity
  • Severe pain the day after exercising
  • Thickening of the tendon
  • Swelling that is present all the time and gets worse throughout the day or with activity
  • Pain on the back of the heal when you wear shoes
Imaging for Non Insertional Tendonitis

  • Weight-bearing X-rays are required
  • MRI scan may be required
Non operative treatment for Non Insertional Tendonitis

A walking CAM (controlled ankle motion) boot or moon boot may help reduce the inflammation. Occasionally a PRP (platelet rich plasma) injection may be offered. This can help promote reduction in inflammation and healing of the tendon. Application of glyceryl trinitrate patch has been shown to be effective.

Surgery for Non Insertional Tendonitis

Surgery is considered if non-operative treatment is unsuccessful after more than 6 months.

It may consist of:

  • Arthroscopic debridement
  • Open debridement of the unhealthy tendon and augmentation of the main Achilles tendon
Risks of Insertional Tendonitis surgery

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

  • Infection: superficial wounds or deep infections
  • Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
  • Nerve damage: tingling, numbness or burning
  • Ongoing pain
  • General or anaesthetic risks including to the heart and lung
  • Drug reactions/allergy
  • Scarring or tethering of the skin
  • Calf weakness
  • Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.  

For all appointments and enquiries, please phone 07 5645 6913 or email info@salusfootsurgeon.com.au

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Benowa QLD 4217

   

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