Non‑Insertional Achilles Tendinitis Treatment in Los Angeles
Achilles tendinitis is a common cause of pain at the back of the heel, and many cases can be treated without surgery. Dr. Alexis Dixon, MD, FAAOS, a board-certified orthopaedic foot & ankle surgeon in Marina del Rey, diagnoses and treats non-insertional Achilles tendinitis.
Foot & Ankle Conditions
What Is Non-Insertional Achilles Tendinitis?
Non-insertional Achilles tendinitis is inflammation of the Achilles tendon in the mid-portion of the tendon, above the heel, and it is a common cause of posterior heel pain. The Achilles tendon is the largest tendon in the body.
When micro-tears develop in the tendon, the body responds by laying down scar tissue. This causes permanent thickening of the tendon, which is often mistaken for swelling. Insertional tendinitis occurs instead where the tendon attaches to the heel bone, sometimes with a bony bump, and you can compare the two on the insertional Achilles tendinitis page.
Get an Accurate Diagnosis
Diagnosis
Dr. Dixon diagnoses Achilles injuries with a focused physical exam, including specific tests for tendon continuity, and imaging when needed. Ultrasound and MRI confirm whether the tendon is inflamed, partially torn, or completely ruptured, and reveal insertional bone changes.
Symptoms
Patients who have this have often also experienced plantar fasciitis in the past, because the cause is similar. Common signs include:
- Pain and stiffness along the tendon, worse in the morning
- Pain that increases with activity
- Swelling and tenderness
- A firm thickening of the tendon that is often mistaken for swelling
What Causes It?
Tendinitis is inflammation of the tendon. It can be caused by overuse, shoe rubbing, inflammatory disorders, a particular shape of the heel bone, and tight calf muscles. It is common in runners and anyone who ramps up activity quickly. The permanent thickening you may feel is scar tissue the body has laid down in response to micro-tears, not fluid swelling.
Conservative First, Surgical When Needed
Treatment Options
Non-insertional Achilles tendinitis can be persistent. Non-operative treatment may take nine months to a year to be effective. However, many patients 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, step forward with the opposite foot toward the wall, and lean against it. Keep the back knee straight and that heel on the ground while the front knee bends, and keep your torso in line with the back leg. You should feel the stretch high on the calf, toward the inside. Do not bounce, and hold for several minutes. 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 for anti-inflammatory dosing. Speak to 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. That is because a heel takes a little tension off the tight calf muscle, and therefore off the Achilles tendon. 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 a therapist can offer make it more effective than a simple home stretching routine.
Surgical Treatment
Surgery is only done after the pain persists despite a prolonged course of non-operative treatment. In most cases, the surgery requires debriding the scar tissue from the Achilles tendon. To protect the tendon from rupture as it heals, the foot must stay in a cast for six weeks with the toes pointed downward, generally without being able to walk on it. The foot is then gradually brought to a neutral position, and physical therapy starts after the cast is removed. Physical therapy is crucial to the recovery after surgery.
The most serious risks are infection of the wound and rupture of the tendon, both attributed to the poor blood supply to this region. Surgical candidates should minimize that risk through smoking cessation, weight loss, and good compliance with the post-operative protocol.
What NOT to Do
Do not get cortisone injections into the Achilles tendon, because it will increase the risk of rupture of the tendon.
Why Choose a Physician
Why See a Board-Certified Orthopaedic Surgeon (MD)?
Dr. Dixon is a board-certified orthopaedic surgeon, an MD with fellowship training in foot and ankle surgery, 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 providers with the depth and breadth of experience to treat the full range 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. That matters here, because non-operative treatment may take nine months to a year and surgery is only done after that course has been given its chance.
After Treatment
What Recovery Looks Like
Without surgery, non-operative treatment may take nine months to a year to be effective, and many patients improve and never go on to need surgery. After surgery to debride the tendon, the foot must stay in a cast for six weeks with the toes pointed downward, generally without being able to walk on it. The foot is then gradually brought to a neutral position, and physical therapy starts after the cast is removed. Physical therapy is crucial to the recovery after surgery.
If nonsurgical: 9 to 12 months
Gradual 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
Non-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 Midtendon Achilles Pain? Get a Real Diagnosis.
If a thickened, tender spot in your Achilles has not settled with rest, get an accurate diagnosis and a clear plan from a board-certified orthopaedic foot & ankle surgeon in Marina del Rey.
Sources
References
The patient handout for this condition draws on the following sources.