What is Insertional Achilles Tendinosis?
Insertional Achilles tendinosis (also known as tendonitis) is a progressive condition that occurs from wear and tear where the Achilles tendon attaches to the heel bone. Recurrent stress on the tendon leads to inflammation, microscopic tearing of the tendon, swelling and pain. It can also be associated with inflammation of the space between the tendon and the calcaneus (heel bone), called the retrocalcaneal bursa.
In the early stages there may be a non-painful lump and pain at the beginning of activity or afterwards. In the advanced state, pain may occur even at rest but may lessen by wearing a shoe with a higher heel or an open back.
Nonsurgical Treatment Options
Treatment depends on the length and severity of the symptoms and many patients improve without surgery. Rest and oral medications may help reduce the swelling and pain and heel cups can decrease pain by relieving some of the stress off of the Achilles tendon when walking. A walking boot or other brace may also be recommended.
Physiotherapy therapy is recommended to work on stretching and improving mobility within the calf muscle. Other treatments may include ultrasound, massage, shockwave therapy and topical nitroglycerin patches. In some cases surgery may be required depending on the location and extent of the tendinosis.
Most cases are successfully treated non-surgically although this is time-consuming and frustrating for active patients. Treatment is less likely to be successful if symptoms have been present more than six months. Non-surgical management includes non-steroidal anti-inflammatory medications, rest, immobilisation, limitation of activity, ice, contrast baths, stretching and heel lifts.