Insertional Achilles Tendonitis

Insertional achilles tendonitis (IAT) is inflammation of the achilles tendon as it inserts on the back of the heel bone or posterior aspect of the calcaneus. IAT most commonly presents with a sudden or gradual onset often leading to chronic posterior heel pain and swelling. The back of the heel becomes very tender, puffy, and intolerable to shoes with a back or heel counter.

Pain is aggravated by increased activity (walking or running) and pressure from shoe gear. Oftentimes, a bony prominence is appreciated both medially and laterally to the insertion of the achilles tendon. Tenderness can be central within the achilles tendon or globally encompassing the entire posterior aspect of the heel.

X-rays often, but not always, may show bone spurs at the insertion site of the achilles tendon or may show erosion of the bone at the area where the achilles tendon inserts.

Initial treatment centers around reducing pressure to the area. This includes wearing open-backed shoes such as flips-flops, sandals, clogs and mules. Non-steroidal anti-inflammatory, steroid therapy, and various physical therapy modalities such as stretching, ultrasound and iontophoresis can be involved with initial treatment. Heel lifts are often incorporated to lift the heel and decrease tension or strain of the achilles tendon on the posterior aspect of the heel.

Corticosteroid injections are not a viable treatment option. There is increased risk of achilles tendon rupture if corticosteroid is injected in or around the achilles tendon.

Resistant cases of insertional achilles tendonitis may require immobilization in devices such as a walking boot, below-the-knee casts and even a short period of complete non-weightbearing.

If no relief is accomplished with the previously mentioned conservative options, surgery may be indicated. If the tendon is diseased and nonviable, or if a tear or partial rupture of the tendon is noted, then repair of the tendon is performed. If the a secondary bone spur or bursa is present, it is usually resected or removed as well.

Surgical repair of the achilles tendon involves a rigorous and prolonged  post-operative recovery and should only be considered as a final option.

If you have insertional achilles tendonitis, please visit our office for a clinical and radiographical evaluation and let us begin your road to recovery and relief as soon as possible. Call 972-542-2155 to schedule an appointment today.