Insertional Achilles Tendinopathy
Heel pain related to insertional Achilles tendinopathy may often mimic the signs and symptoms of mid Achilles tendinopathy and often share the same precipitating factors. Insertional Achilles tendinopathy however can be associated with calcification or increased bone formation in and around the tendon at its insertion. it is also more likely to happen with certain medical conditions which need to be taken into account when prescribing a treatment programme.
The swelling can be on the tendon or around the tendon in the form of bursitis, tissue inflammation or actual bone growth, full evaluation needs to be undertaken so that the treatment programme can be tailored to the clinical and radiological assessments.
The mainstay of treatment initially is physiotherapy and biomechanical treatment programme and the appropriate use of other medical treatment options ranging from therapeutic injections to extracorporeal shock wave treatment.
Medical treatment is not as successful as mid Achilles tendinopathy, there is a higher rate of surgery.
The surgical treatment can vary from release of the gastrocnemius muscle otherwise known as gastrocnemius recession, debridement of the diseased tendon including any calcification and extra bone spurs such as Haglund’s lesion or pump bumps. If the damage is to more than 50% of the tendon then one usually needs to supplement the surgical repair with an FHL tendon transfer.
Surgical treatment is highly effective. The recovery process will vary depending on the extent of surgery required and can vary from 10-12 weeks to 12 months.