Insertional Achilles Tendinitis Treatment in Los Angeles
Achilles tendinitis is a common cause of posterior heel pain, and insertional tendinitis is the form at the back of the heel, where the tendon attaches to the bone. Dr. Alexis Dixon, MD, FAAOS, a board-certified orthopaedic foot & ankle surgeon in Marina del Rey, diagnoses insertional Achilles tendinitis and treats it without surgery wherever she can.
Foot & Ankle Conditions
What Is Insertional Achilles Tendinitis?
Achilles tendinitis is a common cause of posterior heel pain. Insertional tendinitis is the form at the back of the heel, where the tendon attaches to the bone, often with a bony bump. Fortunately, many cases can be treated without surgery.
The Achilles tendon is the largest tendon in the body. Tendinitis is inflammation of the tendon. In the event of micro-tears in the tendon the body responds by laying down calcium deposits, which are commonly called “bone spurs.” The calcium is not the painful portion of the disease but is a helpful sign on x-ray to signal chronic injury to the tendon. If your pain sits in the mid-portion of the tendon, above the heel, you may instead have non-insertional Achilles tendinitis.
Get an Accurate Diagnosis
Diagnosis
Diagnosis starts with an exam plus weight-bearing x-rays, and MRI or CT when needed, to identify the exact injury. The calcium deposits that form in response to micro-tears are not the painful portion of the disease, but they are a helpful sign on x-ray to signal chronic injury to the tendon.
Symptoms
Patients who have this have often also experienced plantar fasciitis in the past. This is because the cause is similar. The signs are:
- Pain and stiffness along the tendon, worse in the morning
- Pain that increases with activity
- Swelling
- Tenderness
What Causes It?
Tendinitis is inflammation of the tendon. This can be caused by overuse, shoe rubbing, inflammatory disorders, a particular shape of the heel bone, and tight calf muscles.
Conservative First, Surgical When Needed
Treatment Options
Insertional Achilles tendinitis can be persistent. Non-operative treatment can take nine months to a year to be effective. However, many patients do improve and never go on to need surgery.
Nonsurgical Treatment
- Calf stretching. Stand about three feet from a wall or counter, turn the symptomatic foot inward slightly, then step forward with the opposite foot towards the wall and lean against the wall. Focus on keeping the back knee straight and the heel against the ground, while the front knee bends. Keep your torso in line with the back leg. You should feel the stretch high on the calf, towards the inside. Do not bounce. Hold this stretch for several minutes. To effectively stretch this muscle when it is tight, aim for about twenty minutes of stretching a day, which you can divide into small increments at your convenience. Stretch both sides to prevent injury on the other side.
- Anti-inflammatories. NSAIDs should be taken around the clock for two to three weeks at anti-inflammatory dosing. Speak with your physician if you have concerns about whether anti-inflammatories are safe for you.
- Heel cup or lift. You may have already found that boots or shoes with a slight heel are more comfortable. This is because it takes a little tension off the tight calf muscle, and therefore off the Achilles tendon. Adding a silicone heel cup with a slight lift in your dress shoes and tennis shoes can make activity more comfortable until your calf becomes less tight.
- Ice. Only use ice if you have no numbness in your feet. If you have any neuropathy, ice application may not be safe. Wrap the ice pack firmly around the area of pain or swelling, with a dry washcloth between your skin and the ice to protect your skin. Ice for up to twenty minutes at a time, and wait an hour before repeating.
- Physical therapy. Physical therapy is commonly prescribed for Achilles tendinitis. The supervision and modalities that therapists are able to offer make it more effective than simple home stretching routines.
What NOT to do. Do not get cortisone injections into the Achilles tendon. This will greatly increase your risk of rupture of the tendon.
Surgical Treatment
Surgery for insertional Achilles tendinitis is only done after the pain persists despite a prolonged course of non-operative treatment. In most cases, the surgery requires complete detachment of the Achilles tendon, removal of the bony prominence, and reattachment of the tendon. For the tendon to heal back to the bone, the foot has to be immobilized in a cast for six weeks with the toes pointed downwards, generally without being able to walk on it. The foot is then gradually brought to a neutral position, and physical therapy is started after the cast is removed. Physical therapy is crucial to the recovery after surgery.
The most serious risk in this surgery is infection of the wound or detachment of the tendon, both attributed to the poor blood supply to this region. For this reason, surgical candidates should minimize their risk of such complications by smoking cessation, weight loss, and good compliance with post-operative protocols.
Why See a Board-Certified Orthopaedic Surgeon (MD)?
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon, not a podiatrist. Foot and ankle orthopaedic surgeons complete medical school, five years of residency training in orthopaedic surgery, and a yearlong advanced fellowship focused on foot and ankle care.
They are the only healthcare providers with the depth and breadth of experience to treat the gamut of foot and ankle conditions, and it is highly recommended to always consult with a foot and ankle orthopaedic surgeon before planning surgery in the region. With insertional Achilles tendinitis, surgery is only done after the pain persists despite a prolonged course of non-operative treatment, and the most serious risk in that surgery is infection of the wound or detachment of the tendon.
After Treatment
What Recovery Looks Like
Non-operative treatment can take nine months to a year to be effective, with calf stretches, anti-inflammatories, a silicone heel lift, ice, and physical therapy. After surgery, the foot has to be immobilized in a cast for six weeks with the toes pointed downwards, generally without being able to walk on it. The foot is then gradually brought to a neutral position, and physical therapy is started after the cast is removed. Physical therapy is crucial to the recovery after surgery.
If nonsurgical: 9 to 12 months
Slow but real improvement with consistent stretching, activity adjustment, and therapy.
If surgery: 6 weeks in a cast
A cast with the toes pointed down and generally no walking on the foot.
After the cast
A gradual return to a neutral position and a committed course of physical therapy.
What Patients Say
Patient Reviews
Patient Questions
Insertional Achilles Tendinitis FAQs
About Your Surgeon
Alexis E. Dixon, MD, FAAOS
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon practicing in Marina Del Rey, California. USC-trained and named an LA Magazine Top Doctor since 2017, she combines surgical expertise with a conservative-first philosophy, treating the underlying joint and tendon, not just the symptom. She treats ganglion cysts, bunions, Achilles injuries, plantar fasciitis, fractures, and the full range of foot and ankle conditions.
Meet Dr. Dixon →Living With Back-of-Heel Pain? Get a Real Diagnosis.
Get an accurate diagnosis and a clear plan from a board-certified orthopaedic foot & ankle surgeon in Marina del Rey. Fortunately, many cases can be treated without surgery.
Sources
References
The patient handout for this condition draws on the following sources.