Insertional Achilles Tendinosis

What is insertional achilles tendinosis?

Insertional Achilles tendinosis is inflammation of the Achilles tendon at its attachment to the heel bone. The Achilles tendon is very important, it is the largest and strongest tendon in the body and responsible for lifting the entire body weight with every step. Insertional Achilles tendinosis often begins with a bone spur that develops on the back of the heel. The spur causes inflammation that extends into the Achilles tendon. Patients usually complain of a painful large red “bump” on the back of their heel. Pain may increase when the back of their shoe presses on the area.

How did I get insertional achilles tendinosis?

Insertional Achilles tendinosis most commonly develops as a result of abnormal biomechanical forces in the foot. These abnormal biomechanical forces can be from trauma or from chronic over use. As the condition progresses the entire back of the heel becomes inflamed.

Should I visit a doctor?

Yes, inflamed tendons are weak tendons. If left untreated the extreme forces placed on the Achilles tendon can cause tearing or even a complete rupture.

What tests will my doctor perform?

Your podiatrist will perform an initial evaluation including a physical exam and x-rays to examine the extent of injury. Ultrasound is commonly used to look for tears in the Achilles tendon and an MRI may also be necessary to fully evaluate the condition.

What treatment is available?

Conservative Treatment may include:

Is surgery an option?

Yes, for patients that don’t respond to conservative therapy surgery is an option. Surgery involves removing the portion of the Achilles tendon that is damaged and also removing the spurs on the back of the heel. There is usually a bursa at the back of the heel as well that must be removed.

Depending on the degree of degeneration in the Achilles tendon, a tendon transfer may also be necessary. The Flexor Hallucis Longus (FHL) tendon is a strong tendon located deep to the Achilles tendon. This tendon provides an excellent source for a graft.  The FHL tendon is transferred into the back of the heel bone just behind the Achilles tendon insertion. This tendon transfer provides reinforcement to the Achilles tendon as well as increased healing capacity, circulation, durability, and ultimate strength to the Achilles tendon.

Post operative recovery usually involves 4-8 weeks with no weight on the foot allowed by progressive rehabilitation focused on strengthening, gait mechanics, and proprioception conditioning.

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