Insertional Achilles Tendinopathy

What is the Achilles Tendon

The Achilles is the tendon that attaches the muscles of the gastrocneumius (calf) and soleus to the back of the calcaneus (heel).

Its main role is to plantarflex the ankle (pointing the foot down) and is responsible for providing most of the force at push off.

What is Insertional Achilles Tendinopathy

Insertional Achilles Tendinopathy is a chronic overuse injury at the insertion of the Achilles Tendon.

People with this problem generally present with pain when first getting out of bed which reduces slightly after walking a short distance and then returns again with extended walking.

Causes of Insertional Achilles Tendinopathy

The Achilles tendon is made up of collagen fibres which are similar to a rope. Insertional Achilles Tendinopathy involves chronic degeneration at the insertion of the Achilles.

Click for more in depth information on the pathophysiology of Achilles Tendinopahy

Certain factors are though to increase the risk for the development of insertional Achilles Tendinopathy including:

  • Bony Irritation – It is also a common feature to have a prominent bone at the back of the heel with this particular problem either a Haglunds deformity or a retrocalcaneal exostosis. Haglunds deformity is a bony prominence that is higher up on the calcaneous when compared to a retrocalcaneal exostosis which typically has an intratendenous component.
  • Certain medications (Fluoroquinolones – ciprofloxacin)
  • Non- Supportive footwear
  • Flat arched feet
  • High arched feet
  • Sudden increase in activity
  • Trauma
  • Being overweight
  • Hormone problems (Reduced Thyroid function, Menopause)
  • Connective tissue disorders (Rheumatoid arthritis)

Diagnosis of Insertional Achilles Tendinopathy

Diagnosis is generally made with specific signs and symptoms – when the pain occurs and the location.

At the Foot an Ankle Centre we are able to provide additional information about the presence of Insertional Achilles Tendinopathy with ultrasound imaging.

Typically someone with Insertional Achilles will have disorganisation at the insertion of the Achilles

Xrays also provide valuable information about any possible bony cause for the irritation of the tendon.

Treatment of Insertional Achilles Tendinopathy

Treatment needs to reduce the disorganisation of the connective tissue in the Achilles tendon and also minimise some of the risk factors. This can include

  • Shockwave therapy
  • Orthotic correction
  • Stretching Alfredson Eccentric Stretches
  • Taping
  • Home Massage techniques
  • Night Splinting
  • Surgery to remove any osseous components and repair the tendon

What else could it be? (differential diagnosis)

Other problems that can cause similar pain to a neuroma include:

Retrocalcaneal bursitis

Kagers Fat Pad Inflammation

Tarsal Tunnel Syndrome

Tibialis posterior tendon dysfunction

 


 

The Ankle, Foot and Orthotic Centre’s Northcote Podiatrists can help you with all lower limb complaints, including Plantar Fasciitis. Make an appointment to get your foot and ankle pain under control.

Expert Podiatrists for the treatment of Plantar fasciitis servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston

 

Call The Ankle and Foot Centre in Northcote for further advice on professional management and treatment options.