Insertional Achilles Tendinitis
The Achilles tendon is the largest tendon in the body. Insertional Achilles tendinitis is a degeneration of the Achilles tendon fibers where the tendon inserts into the heel bone. It may be associated with inflammation of a bursa or tendon sheath in the same area.
Symptoms
Most patients report a gradual onset of pain and swelling at the back of the heel bone without specific injury. At first, the pain may only be noticeable after activity, but it becomes more constant over time. The pain increases with jumping or running and especially with sports requiring short bursts of these activities. Patients experience tenderness over the back of the heel bone and the bone often becomes more prominent. It is painful to position the ankle above a 90 degree position.
Causes
Insertional Achilles tendinitis primarily is caused by degeneration of the tendon over time. The average patient is in their 40s. Conditions associated with increased risk include psoriasis and Reiter’s syndrome, spondyloarthropathy (generalized inflammation of joints), gout, familial hyperlipidemia, sarcoidosis, and diffuse idiopathic skeletal hyperostosis as well as the use of medications such as steroids and fluoroquinolone antibiotics.
Diagnosis
Your foot and ankle orthopedic surgeon will perform a clinical exam to determine if you have insertional Achilles tendinosis. They may order X-rays to look for calcification (bone) deposits within the tendon at its insertion into the heel. These deposits are present approximately 60 percent of the time and are associated with a more guarded success rate for non-surgical treatment and a much longer recovery time for surgical treatment. X-rays also may reveal a Haglund’s deformity.
MRIs may be used to determine the extent of tendon degeneration as well as other factors such as bursitis, which may contribute to heel pain.
Treatments
Non-surgical Treatment
Non-surgical treatments, including liberal use of nonsteroidal anti-inflammatory drugs, heel lifts, stretching, and switching to shoes that do not put pressure over this area, are effective for the majority of patients. If symptoms persist, your surgeon may recommend night splints, arch supports, physical therapy, or the use of a cast or brace. Nitroglycerin patches also may be of benefit to increase the blood supply to this area.
