Also, see:https://santabarbaradeeptissue.com/index.php/2020/04/10/pro-sports-massage-for-achilles-tendinitis/ What is insertional Achilles tendonitis? Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone. In both non insertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis. Insertional Achilles Tendinitis is pain and inflammation at the insertion of the Achilles Tendon on the heel bone. It is often associated with swelling, redness, and calcium buildup (small bump) located at the back of the heel (see picture). Pressure at the back of the heel tends to be sensitive and painful. In the clinic, some of my clients often report that certain tight shoes might cause more pain in this area from the pressure and have to sometimes resort to open back shoes. Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone. In both non insertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis. Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active. More often than not, however, it comes from years of overuse (long-distance runners, sprinters). Once the inflammation in your Achilles tendon has been reduced, nourishing and strengthening the tissue in the Achilles tendon and surrounding area is recommended.
When you have a tendon injury, there is not much blood flow in your injured tendon, especially if it is in the watershed zone, which it probably is. Inflammation and reduced movement (lack of activity or ongoing immobility) reduce the flow of blood to an area that is already receiving very little blood flow. If you are moving your injured Achilles around you run a risk of increasing the severity of the injury. If there has been some healing, you could re-injure your tendon all over again.
Cause
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including:
- A sudden increase in the amount or intensity of exercise activity—for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance
- Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon
- Bone spur—Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain
Symptoms
Common symptoms of Achilles tendinitis include:
- Pain and stiffness along the Achilles tendon in the morning
- Pain along the tendon or back of the heel that worsens with activity
- Severe pain the day after exercising
- Thickening of the tendon
- Bone spur (insertional tendinitis)
- Swelling is present all the time and gets worse throughout the day with activity
Examination
After you describe your symptoms and discuss your concerns, the doctor will examine your foot and ankle. The doctor will look for these signs:
- Swelling along the Achilles tendon or at the back of your heel
- Thickening or enlargement of the Achilles tendon
- Bony spurs at the lower part of the tendon at the back of your heel (insertional tendinitis)
- The point of maximum tenderness
- Pain in the middle of the tendon, (non insertional tendinitis)
- Pain at the back of your heel at the lower part of the tendon (insertional tendinitis)
- Limited range of motion in your ankle—specifically, a decreased ability to flex your foot
Non-Surgical Treatment Options
Conservative non-surgical treatment remains effective in the majority of patients with liberal use of nonsteroidal anti-inflammatory drugs, heel lifts, stretching, and shoes that do not provide pressure over this area. If symptoms persist, then night splints, arch supports, and physical therapy may be of benefit. If this fails, then application of a cast or brace with a gradual return to activity is indicated. Nitroglycerin patches may also be of benefit in an attempt to increase the blood supply to this area.Achilles Tendon Facts
There are over 250,000 Achilles tendon injuries each year in the US.
How do you know if you have insertional Achilles tendonitis?
Symptoms
- 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.
How common is insertional Achilles tendonitis?
Approximately 6% of the general population reports Achilles tendon pain during their lifetime. Of these patients, roughly one-third will have insertional Achilles tendinopathy (IAT). Patients with IAT often report stiffness that is aggravated by prolonged rest as well as pain that is aggravated by physical activity.
Does insertional Achilles tendonitis require surgery?
Surgery for insertional Achilles tendinopathy is a last resort procedure when all other treatment modalities have failed. This is normally performed as a day surgical procedure although on occasions you may need to stay overnight.
Why is insertional Achilles tendinitis so painful?
Insertional tendonitis involves inflammation at the point where the Achilles tendon inserts into the heel bone. People with this condition often have tenderness directly over the insertion of the Achilles tendon, which is commonly associated with calcium formation or a bone spur forming just above the insertion point.
Do night splints help insertional Achilles tendonitis?
Conservative non-surgical treatment remains effective in the majority of patients with liberal use of nonsteroidal anti-inflammatory drugs, heel lifts, stretching, and shoes that do not provide pressure over this area. If symptoms persist, then night splints, arch supports, and physical therapy may be of benefit.
Should you massage insertional Achilles tendonitis?
Conclusion: Pressure massage is a useful treatment for Achilles tendinopathy. Compared with eccentric exercise treatment, pressure massage gives similar results. Combining the treatments did not improve the outcome.
Is stretching good for insertional Achilles tendonitis?
If you have Achilles tendonitis or other Achilles tendon issues, you can do stretches to help recovery. These moves improve mobility by loosening up the tendon. Strengthening exercises can also tone the calf and heel muscles attached to the tendon.
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 taking 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 the 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.more info at: https://aidmyachilles.com/tendon-muscle-injuries-in-the-leg/tendinopathy-tendon-disease.php?gclid=EAIaIQobChMI1oeKxqK39AIVpiCtBh1z4gt7EAAYASAAEgLptfD_BwE https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/Insertional Achilles Tendonitis Treatment and Symptomshttps://www.healthline.com/health/achilles-tendon-stretch https://www.tri-countyortho.com/patient-resources/education/insertional-achilles-tendonitis-treatment-options
