Achilles tendon issues commonly include
Tendinopathy, characterised by degenerative changes and chronic pain due to overuse, and
Acute ruptures, which involve a complete or partial tear of the tendon fibres typically following a sudden increase in stress or trauma.
Paratenonitis, an inflammation of the tissue surrounding the tendon, and
Insertional Achilles Tendinopathy, where degeneration occurs at the tendon’s attachment to the calcaneus.
Management varies depending on the specific pathology, with conservative approaches prioritised initially but surgical intervention considered in refractory or severe cases.
Insertional Achilles Tendinitis
Introduction
Insertional Achilles tendinitis is a clinical condition characterised by pain and inflammation at the site where the Achilles tendon attaches to the calcaneus (heel bone).
It primarily affects physically active individuals, particularly those engaged in repetitive strain activities such as running or jumping.
Understanding the underlying causes, pathophysiology, and clinical presentation is essential for timely diagnosis and effective management.
What is Insertional Achilles Tendinitis?
Insertional Achilles tendinitis refers to the degeneration, inflammation, and microtearing occurring at the tendon’s insertion point on the posterior aspect of the calcaneus.
Unlike non-insertional Achilles tendinitis, which affects the mid-portion of the tendon, insertional tendinitis involves the distal segment and frequently associates with bone spurs or calcification.
It is a form of tendinopathy characterised by collagen disorganisation, neovascularisation, and sometimes enthesophyte (spur) formation.
Why Do People Get Insertional Achilles Tendinitis?
The condition results from repetitive mechanical overload and microtrauma to the tendon insertion site. Factors contributing to its development include:
Overuse: Repeated strain from running, jumping, or other high-impact sports.
Biomechanical abnormalities: Poor foot mechanics or limited ankle dorsiflexion increasing stress on the insertion site.
Age-related degenerative changes: Tendon vascularity diminishes with age, reducing the tendon’s ability to heal microdamage.
Improper footwear: Shoes that exert pressure on the heel or fail to provide adequate support can exacerbate stress.
Weight-related factors: Elevated body mass indexes increase load on the tendon attachment, potentially accelerating pathology.
Systemic conditions: Some metabolic or inflammatory disorders may predispose to tendon pathology.
Common Signs and Symptoms of Insertional Achilles Tendinitis
Patients commonly present with:
Localized pain and tenderness: Pain is typically located at the back of the heel around the tendon insertion site and is aggravated by activity.
Swelling and thickening: The insertion area may show signs of inflammation, including swelling or nodular thickening.
Stiffness: Especially noticeable in the morning or after periods of rest.
Decreased range of ankle motion: Particularly dorsiflexion may be limited due to pain and tendon stiffness.
Pain on palpation: Tenderness on palpating the posterior calcaneus or Achilles tendon insertion.
Pain exacerbated by activity: Elevated discomfort during or after exercise and relief with rest.
This summary encapsulates current understanding from peer-reviewed orthopaedic and sports medicine literature, providing a foundational overview for clinicians managing patients with insertional Achilles tendinitis.