Insertional Achilles Tendonitis

Overview

Did you know the Achilles tendon is the largest tendon in your body? It is formed by the merging of the upper calf muscles and it works to help you bend your knee and point your toes down. If you can also roll your heel slightly inwardly, that’s thanks to your Achilles tendon. The tendon inserts into your heel bone.

What is insertional Achilles tendonitis?

Insertional Achilles tendonitis is an inflammatory reaction in the tendon at the back of the ankle where it inserts into the heel bone. The condition can be either acute or chronic and symptoms include pain on touching the back of the ankle. It can be a sharp pain or a dull ache. There may also be a lump on the heel if the problem is due to overuse or chronic injury. There can also be general swelling or redness. Acute insertional tendonitis can be brought on through repeated friction in the area and it is therefore common in athletes. The condition can be associated with the inflammation of a bursa or tendon sheath in the same area.

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Symptoms of Insertional Achilles Tendonitis

Most patients experience pain which comes on gradually and swelling in the Achilles tendon. The pain is associated with activity in the early stages but as time goes on, it becomes more constant. Running and jumping while playing sports can make the pain worse. The back of the heel bone may feel tender and pain limits the placement of the ankle in certain positions.

Causes of Insertional Achilles Tendonitis

The condition is usually caused by a degeneration of the tendon. Risk factors include Reiter’s syndrome, spondyloarthropathy, gout, familial hyperlipidemia, sarcoidosis and diffuse idiopathic skeletal hyperostosis. The use of steroids and fluoroquinolone antibiotics is also associated with increased risks. Patients are most commonly in their 40s.

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Diagnosis and treatment

Insertional Achilles Tendonitis is primarily a clinical diagnosis. X-rays may show deposits of calcium in the tendon at its insertion into the heel some of the time. Calcification is associated with a less optimistic rate of success for non-surgical treatment. Recovery time after surgery is also longer. X-rays may also reveal Haglund’s deformity which is a bony enlargement on the back of the heel.  Magnetic resonance imaging (MRI) can help to show the extent of tendon degeneration as well as other factors which may contribute to heel pain.

Many patients find pain relief through the use of nonsteroidal anti-inflammatory drugs, heel lifts, stretching and comfortable shoes. Night splints, arch supports, and physical therapy can also be tried. If all these methods fail, then using a cast or brace for a while may be helpful before resuming activity gradually, Nitroglycerin patches can be used to increase the blood supply to this area.

If no non-surgical treatment work, the solution may be to remove the degenerative parts of the tendon, any bone that is irritating the tendon or any inflamed bursa tissue. Lengthening a short tendon may also be necessary. Another solution may be to strengthen the tendon attachment to the heel bone with sutures that attach directly to the bone. Success rates vary among patients.

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Recovery and potential complications

After a surgical procedure, the patient must wear a splint is worn for two weeks in a toe-down position. This allows the wound to heal.  When healing begins, weight-bearing in a cast or brace in a toe-down position can be started along with range-of-motion exercise. Physical therapy begins around four to six weeks after surgery and athletes can usually resume activities after eight to 12 weeks.

The time period depending on how much of the tendon was detached when the operation was performed. Some patients may take one to two years to recover after surgical and non-surgical treatment. Because the blood supply to the skin and tendon is poor, there’s the possibility of wound complications, infections, and tendon detachment.fee