Achilles Tendinopathy

What is Achilles Tendinopathy?

The Achilles tendon is a tough band of tissue that attaches your calf muscles (gastrocnemius and soleus) to the back of your heel. It bears very large loads during “push off “required for running, jumping and other high impact activities.

Achilles Tendinopathy is a painful, degenerative condition of the Achilles tendon which can occur at:

  1. The midsubstance of the Achilles tendon (Non-Insertional Tendinopathy).
  2. Its attachment to the heel (Insertional Tendinopathy).

Non-Insertional Tendinopathy

Non-insertional Tendinopathy is a painful and chronic degenerative process where small cracks and splits develop in the midsubstance of the Achilles tendon. It is often associated with “overuse” of the tendon. The plantaris is a small tendon that lies next to the Achilles tendon which may become inflamed and contribute to symptoms.

Symptoms

Pain above the heel is the major complaint. Initially patients may experience pain with the first steps in the morning. This pain progresses until pain is experienced constantly with activity.

When this condition has been present for a prolonged period of time, you may notice an obvious lump at the mid portion of the Achilles tendon.

MRI showing a thickened Achilles tendon

Treatment

Non-operative treatment is successful in about 80% of patients with Non- Insertional Tendinopathy.

Non-operative treatment includes:

  • Resting in a boot (possibly with a heel raise).
  • Physiotherapy or Podiatric intervention involves stretching and strengthening exercises.
  • Lifestyle modification ie. avoiding aggravating activity.
  • Anti-inflammatory medication used in moderation.
  • Shock Wave Therapy involves pulsed ultrasonic waves via a probe placed on the zone of injury to encourage the healing process.
  • Platelet Rich Plasma (PRP) or blood injections.


If symptoms persist after about 9 months of non-operative treatment, surgery may be necessary. Surgical treatment can range from minimal to more invasive procedures. What option is best for you will be discussed, in depth, with Mr Goldbloom.

Click here for more information on Surgery for Non-Insertional Tendinopathy  

Insertional Tendinopathy

Insertional Tendinopathy is a condition of the Achilles tendon which involves injury where it attaches to the heel. This condition is associated with other terms such as “Retrocalcaneal bursitis”, Haglund deformity, and Pump bump.

The retrocalcaneal bursa is a fluid filled sac that normally provides protection for the Achilles tendon from rubbing on the heel bone. This bursa can be become inflamed.

X-ray may show an abnormal shape that looks like a bump on the back of the heel.This is known as a Haglund deformity and this can place extra pressure on the tendon.The tendon can undergo calcific change as a response to the extra stress placed on it.

Symptoms

Pain is experienced at the back of the heel and there may be an associated lump. Initially patients may experience pain with the first steps in the morning and with walking uphill.This pain progresses until pain is experienced constantly with activity. Footwear can make symptoms worse by rubbing over the lump.

MRI showing a thickened Achilles tendon

Treatment

The non-operative treatment of this condition is very similar to non-insertional tendinopathy, as above.

If symptoms persist after about 9 months of non-operative treatment, surgery may be necessary. The type of surgical treatment depends on a number of factors. What options is best for you will be discussed in depth with Mr Goldbloom.

Click here for more information on Surgery for Insertional Tendinopathy  

Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Please contact Mr Goldbloom's rooms to discuss if surgery is appropriate for your situation.