Insertional Pain of the Achilles Tendon

Description and Symptoms

Insertional pain of the Achilles tendon occurs at the site where the Achilles tendon inserts on the back of the heel bone.  The tendon and its covering, the paratenon, become inflamed, and a spur may form at the back of the heel.  This condition can be caused by chronic overuse of the Achilles, a flatfoot deformity, or an acute injury.  

Diagnosis

There is often swelling accompanying the pain at the back of the heel.  The tendon itself may be thickened and could have degeneration within the tendon tissues.  Diagnosis is often made upon clinical examination.  Further imaging, such as MRI or ultrasound, may be used to confirm the diagnosis or to evaluate the integrity of the Achilles tendon.  These symptoms can exist simultaneously with plantar fasciitis, and are sometimes mistaken for it.

Treatment

Treatments include the use of heel lifts, orthotics, a walking cast, stretching exercises and physical therapy.  Cortisone injections are not recommended in this location for risk of tendon rupture.  Conservative therapies are often successful, but in some cases surgery is indicated to remove a spur or repair portions of diseased tendon.   

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