Top tips for insertional Achilles tendinopathy

Insertional Achilles tendinopathy is a very specific kind of tendinopathy. In this article, Maryke explains why you should not treat it the same as the more common midportion Achilles tendinopathy, and she shares some tips on how best to alleviate the injury.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. What is insertional Achilles tendinopathy?

2. A key difference between midportion and insertional Achilles tendinopathy rehab

3. How to be kind to your insertional Achilles tendinopathy

4. How we can help

I've also discussed it in this video:

What is insertional Achilles tendinopathy?

Insertional Achilles tendinopathy develops where your Achilles tendon is attached to your heel bone (see video below). This occurs lower down in the Achilles tendon than midportion Achilles tendinopathy, and it is important to distinguish between the two because the treatments are very different.

The insertional type is usually caused by excessive compression. In that area, where the Achilles tendon attaches to the heel bone, the tendon naturally compress against the bone. This is normal and not usually a problem unless you do an activity that causes a lot more compression than what the tendon is used to.

A key difference between midportion and insertional Achilles tendinopathy rehab

Heel raises done over the side of a step, where you drop your heel to below the level of the step before you raise up again, play an important part in the rehab programme that we prescribe for our patients with midportion Achilles tendinopathy. However, of you have insertional tendinopathy, this dropping of the heel will compress your tendon against your heel bone and actually aggravate your injury.

So, at the start of a rehab programme for patients with insertional Achilles tendinopathy, we get them to do heel raises on the floor or even with shoes on, so that they do not get into any position where it compresses the tendon. It is only much later on, when the patient is well on their way to recovery, that we add in heel raises over the side of a step.

How to be kind to your insertional Achilles tendinopathy

One of the nicest things you can do for your tendon, especially if it is acutely flared up and painful, is not to walk around barefoot or in flat shoes. Rather put your feet into comfortable shoes – ones that do not press directly on that spot and also have a bit of a heel, such as regular running shoes. The heel of most types of running shoes is raised about 12 degrees.

Alternatively, you can use insoles – obviously in both shoes so that you have an even gait – to lift the heel a bit. Heel inserts that are quite high can make a huge difference if the tendon is flared up badly, because it takes the strain off that injured tissue and allows it to calm down.

Of course, as you recover, we want to bring the foot into a position where it is happy to take your load while it is flat, but at the beginning stages it is really useful to just lift the heel up a bit so that we can desensitise the tissue and allow it to recover.

Also, if you have an insertional Achilles tendinopathy, avoid calf stretches, because it has the same effect of compression of the tendon against the heel bone as doing a heel raise over the side of the step.

So, to summarise: Avoid heel raises over the side of a step and calf stretches until you are well recovered, and wear shoes with a bit of a heel or get heel inserts to take some of the strain off that area.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.

References

1. Cook, J. L., et al. (2018). "Insertional and mid-substance Achilles tendinopathies: eccentric training is not for everyone–updated evidence of non-surgical management." Journal of Manual & Manipulative Therapy 26(3) 199-122.