What You Should Know About Insertional Achilles Tendinopathy

Understanding Insertional Achilles Tendinopathy

Definition and Symptoms

Insertional Achilles tendinopathy involves the part of the Achilles tendon that attaches to the heel bone. This condition is characterized by a gradual onset of pain and swelling without a specific injury.

The pain may worsen over time and can be exacerbated by activities such as jumping, running, or walking uphill.

Common symptoms include:

• Pain at the back of the heel
• Swelling around the Achilles tendon
• Stiffness, especially in the morning
• Tenderness when touching the affected area

Causes and Risk Factors

Insertional Achilles tendinopathy is often caused by repetitive activity over a long period of time, making it a common issue among runners. However, several other factors can contribute to the development of this condition (NCBI).

Common Causes:

• Repetitive stress from activities like running or jumping
• Sudden increase in physical activity or changes in training routines
• Wearing improper footwear

Risk Factors:

• Age: Older individuals are more prone to tendinopathy.
• Diabetes: Increases the risk of tendon issues.
• Weight: Being overweight can put additional stress on the Achilles tendon.
• Steroid Use: Can weaken tendons over time.
• Sedentary Lifestyle: One-third of patients with Achilles tendinopathy have a sedentary lifestyle.

Clinical Risk Factors:

• Prior lower limb tendinopathy or fracture
• Use of ofloxacin antibiotics
• Moderate alcohol use
• Training during cold weather
• Decreased isokinetic plantar flexor strength
• Abnormal gait pattern
• More lateral foot roll-over at the forefoot flat phase
• Creatinine clearance of <60 mL/min in heart transplant patients

For more information on related ankle conditions, you can explore our articles on achilles tendinopathy, heel pain, and sprained ankle.

Conservative Treatment Options

When dealing with insertional Achilles tendinopathy, non-surgical treatments are often the first line of defense. These methods aim to reduce pain and improve function without the need for surgery (NIH).

These treatment options should be treated as a general guideline, always consult with a healthcare professional for personalized guidance on tendinopathy treatment and medication that is right for you.

Exercise and Physical Therapy

Exercise has the highest level of evidence supporting its ability to reduce insertional Achilles tendinopathy (IAT) pain, with a Grade A recommendation. A structured exercise program can help strengthen the tendon and improve flexibility.

Physical therapy often includes:

• Eccentric exercises: These exercises involve lengthening the Achilles tendon under tension, which can help in reducing pain and improving function.
• Soft tissue treatment: Techniques such as massage and myofascial release can help alleviate pain and improve mobility.
• Nutritional supplements: Supplements like omega-3 fatty acids and collagen may support tendon health.
• Iontophoresis: This involves using electrical currents to deliver anti-inflammatory medications directly to the affected area.
• Education: Understanding the condition and how to manage it can empower you to take an active role in your recovery.
• Stretching and heel lifts: While stretching may worsen pain for some, heel lifts can reduce strain on the Achilles tendon.

Injections and Other Modalities

Injections may be considered for patients with IAT who have failed other conservative treatment options, particularly as a means to facilitate participation in an exercise program. Options include:

• Corticosteroid injections: These can reduce inflammation but carry a risk of tendon tear, so they are used cautiously.
• Sclerosing therapy with polidocanol: This involves injecting a sclerosing agent to reduce neovascularization and pain.
• Platelet-rich plasma (PRP) injections: PRP uses your own blood components to promote healing.

Other non-surgical treatments include:

• NSAIDs: Non-steroidal anti-inflammatory drugs can help manage pain and inflammation.
• Heel lifts: These can reduce strain on the Achilles tendon.
• Supportive shoes and orthotics: Proper footwear can provide additional support and reduce stress on the tendon.

For more information on managing tendinopathy, visit our articles on tendinopathy and achilles tendinopathy.

Surgical Interventions

Surgery for insertional Achilles tendinopathy is typically recommended for patients who do not experience improvement after 3-6 months of non-surgical treatment.

The specific type of surgery depends on the extent of the damage to the Achilles tendon (NIH). Common surgical procedures for insertional Achilles tendinopathy include:

• Debridement: This procedure involves removing the diseased portion of the tendon and any bone spurs that may be contributing to the condition. In cases where the tendon is severely damaged, a tendon transfer may be performed to reinforce the Achilles.
• Gastrocnemius Recession: This procedure involves lengthening the calf muscle to reduce tension on the Achilles tendon. It is often used when there is limited ankle flexibility contributing to the tendinopathy.
• Minimally Invasive Surgery: In some cases, minimally invasive techniques may be used to address the damaged tendon and bone spurs. These procedures typically involve smaller incisions and may result in a quicker recovery time.

While surgical outcomes are generally positive, with studies reporting a return to pre-surgical activity levels in up to 75% of patients and a 90% patient satisfaction rate (OrthoInfo), there are risks involved. Potential complications include infection, nerve damage, and continued pain in the same area.

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Focusing on treating impacted connective tissue, also known as fascia, that surround the affected tendon to promote healing and enable further support for nearby musculoskeletal structures. RELIEF® is a minimally invasive alternative to traditional treatments—and requires no steroids, medication, surgery, anesthesia, or post-procedure immobilization.

‍Contact us today to schedule a consultation and learn more about how RELIEF® may help tendinopathy and tendonitis.