What is Achilles insertional tendinopathy?

Pain at the back of the heel where the Achilles tendon joins the heel bone is a common problem.

What causes Achilles insertional tendinopathy?

Compression between the Achilles tendon and the heel bone is considered to be a key factor in insertional Achilles tendinopathy. This is likely to occur when walking uphill or on small inclines, especially when wearing flat shoes.

What are the symptoms?

• Pain and stiffness: Usually, there is pain and stiffness, especially when first walking after rest, at the back of the heel where the Achilles tendon attaches to the heel bone. Symptoms may ease after walking for a few minutes, but this pattern can repeat throughout the day.
• Worse with activity: Though the pain tends to ease as you walk, prolonged walking will cause the pain to return and increase.
• Occasional redness or warmth: Occasionally, the back of the heel where the Achilles tendon joins the bone may become red or warm.

What should I do if I have Achilles insertional tendinopathy?

• Rest and activity changes: Rest or at least reduce activity to allow symptoms to settle. If you need to walk to maintain fitness, avoid walking uphill or on inclines and stick to flat ground.
• Footwear: Avoid flat shoes and wear shoes with a two centimetre (or three-quarter inch) heel. This will reduce the compression between the tendon and the heel bone.
• Heel cushions: A silicone heel cushion/cup may help. Ensure you use one in both shoes to avoid leg length discrepancy, which could cause back pain.

What treatments can help Achilles insertional tendinopathy?

Loading exercises

These exercises, performed on a flat surface, have proven effective. Although they may be painful in the early stages, they can significantly help over time.

Note: These exercises can cause pain. For safety, make sure you are holding onto a handrail or a secure piece of furniture for balance.

1. Stand on a flat surface and go up onto tiptoes with both feet.
2. Slowly lower the heels of both feet to the ground.
3. Continue this exercise until your podiatrist advises you to progress to single-leg exercises.

Shockwave therapy

This non-invasive treatment uses sound waves to promote healing in the Achilles tendon. It can be effective for some patients and may reduce pain and improve function.

Orthotic devices

Special shoe inserts may be prescribed; they help by providing support and reducing strain on the Achilles tendon. These are often used in conjunction with other treatments to improve outcomes.

Will a steroid injection help?

Steroid injections are not advised. They may provide temporary relief but are not a cure and could lead to tendon rupture, so they are best avoided.

Do I Need an X-ray or a scan?

Not always, especially if no specific injury or event caused the problem and you can stand on tiptoe in single-limb support on the painful side. If symptoms do not improve with loading exercises after three months, an ultrasound should be considered to exclude more severe injury to the tendon.