One painful type of chronic Achilles tendonitis, called “Insertional Achilles Tendonitis,” occurs when the fibers become inflamed where the tendon connects to the heel bone.
This form of tendonitis can affect anyone, even those who are not overly active. In most cases, though, insertional Achilles tendonitis is the result of overuse in either athletes like marathon runners or in sports that require sprinting and jumping.
Likewise, it can be common for workers where on-the-job movements place continual stress on this area of the Achilles.
Pain in this area of the Achilles can also be the result of trauma, such as partial tears in the tendon or a complete rupture from a severe amount of direct stress.
What is Achilles Tendonitis?
The Achilles Tendon, also called the Calcaneal Tendon or heel cord, is the largest tendon in the human body, and it runs down the back of the calf and connects to the heel bone.
This strong cord of fibrous soft tissue supports a broad range of human movement, such as:
- Standing on our tiptoes
- And, of course, walking
Tendons are the soft tissues that hold muscles and bones together. They are made of collagen, which the human body produces less of as we age. This is why disorders like insertional Achilles tendonitis are common among older, veteran athletes. It also accounts for why tendon strains and injuries are more likely as we get older, whether we’re athletes or not.
With injury, overuse, repetitive movements, or even some types of illness, tendons can swell and become inflamed. This condition is known as “tendonitis.”
Two types of Achilles Tendonitis – “Non-Insertional” and “Insertional Achilles Tendonitis.”
- Insertional Achilles Tendonitis affects the lower part of the Achilles where the tendon attaches to the heel bone.
- Non-insertional Achilles Tendonitis impacts the fibers in the middle area of the tendon above the heel bone. This type of injury is more common with younger people who are very active.
While this is generally seen as an overuse injury, it can be caused by other reasons as well.
If fibers in a damaged Achilles begin to harden and calcify, this can also lead to serious pain and discomfort.
Insertional Achilles Tendonitis Symptoms
Many people will experience some form of pain or stiffness gradually develop over time from training too hard or for too long. This can be accompanied by swelling in the affected area or a slight sensitivity when touched.
Because each person is different, some will have pain while exercising or training, while others might only notice it after they finish a run or workout. It can also be noticeable early in the morning before loosening up from walking.
Insertional Achilles Tendonitis Symptoms frequently include some of the following:
- Swelling or inflammation at the back of the heel
- Intense pain during activities that place stress on this part of the Achilles, such as running, jumping or even walking
- Tenderness or soreness on the back of the heel
- Heel bone may become more prominent
- Discomfort or pain when flexing the ankle above a 90 degree position that stretches the Achilles
Diagnosis and Achilles Tendonitis Treatment
With continued irritation or pain, it is important to see a physician to ensure proper Achilles Tendonitis treatment.
After a physical examination and considering a person’s medical and physical history, sports medicine physicians are likely to suggest an MRI (magnetic resonance imaging), X-rays, or an ultrasound to get a clearer look at the affected area of the tendon.
Insertional Achilles Tendonitis treatment can include surgery or non-surgical options.
Achilles Tendonitis Surgery
Treatment for serious Achilles injuries, like severe tears or total ruptures, can require Achilles tendonitis surgery in order for a person to fully recover and regain complete range of motion.
Surgery is sometimes seen as a last resort only for severe injuries or a torn Achilles that necessitates repair. It is an invasive procedure that requires anesthesia and a long period of downtime for recovery after the procedure.
Surgery can also be further complicated by infection, healing issues, or continued pain in the injured area.
Non-Surgical Treatment for Achilles Tendonitis
Non-surgical options are always preferred, which is why it’s so important to have an assessment at the first signs of pain or injury.
An early diagnosis can prevent further damage or injury, with better chances of healing more quickly and avoiding surgery altogether.
Non-surgical treatments for insertional Achilles tendonitis may include some of the following:
Resting the Achilles by avoiding exercises or movements at the first sign of pain is highly recommended. This is especially true right after an injury occurs, as the Achilles may need time to heal from an acute injury. This can take time, so it’s important to avoid any type of exercise until it fully heals and the pain subsides.
Icing the Achilles tendon can reduce some of the inflammation and may help decrease the pain. Ice the area for 20 minutes at a time, every few hours for one or two days at the first onset of pain or injury.
3. Anti-inflammatory Medications
Nonsteroidal anti-inflammatory medications like ibuprofen can help reduce both swelling and pain, and can be purchased without a prescription.
4. EPAT Therapy Treatment (Shockwave)
EPAT Therapy (Shockwave) is a non-invasive method for speeding up healing through the use of impulse pressure waves delivered to the injured Achilles. This increases blood flow, decreases pain, and can lead to a quicker recovery time.
For athletes who cannot afford to stop training even with a minor Achilles injury, EPAT therapy combined with low impact exercises like elliptical machines, swimming, or biking can help speed up recovery.
Because EPAT Treatment is a non-surgical option, anesthesia is not necessary, and there is no scarring, or risk of infection.
Many sports medicine professionals use EPAT Treatment because it provides many benefits, including faster recovery times.
5. Heel Lift and Walking Boot
For people who must be on their feet while waiting for an Achilles injury to heal, a walking boot can provide support and a one-inch heel lift or wedge inserted into the boot can help remove further strain on the Achilles tendon.
6. Physical Therapy
Physical therapy is useful for flexibility and injury prevention, especially by learning proper form for any particular Achilles movement. Physical therapy should focus on specific Achilles tendonitis exercises to strengthen muscular support in this area.
Preventing Insertional Achilles Tendonitis and Recovery
Depending on a person’s age and level of physical activity, it’s impossible to always avoid injury. However, it’s important not to rush back into exercise or other physical activities while the Achilles is still healing.
Whenever possible, take the return to sports, exercise, or work activity slowly.
Be sure to always wear the best shoes for Achilles tendonitis pain to prevent further strain or injury. Avoid wearing sandals or lightweight shoes with minimal support, and opt for footwear that provides the most support and comfort.
Lastly, get into the habit of warming up before any strenuous activity, being deliberate and cautious with each movement, and always take the time to stretch the Achilles before and after physical activity.
Everyone wants to avoid any type of injury, but some are worse than others. Insertional Achilles Tendonitis or other Achilles injuries can take 6 to 12 months to properly heal depending on the severity of injury.
Seriously torn or ruptured tendons that require surgery might sometimes require up to a year or more for a full recovery and a return to sports activities.
Achilles Tendon image by OpenStax (J. Gordon Betts, Kelly A. Young, James A. Wise, Eddie Johnson, Brandon Poe, Dean H. Kruse, Oksana Korol, Jody E. Johnson, Mark Womble, Peter DeSaix)