Insertional Achilles tendonitis is a common condition in older people who participate in repetitive activities such as running. It causes pain, inflammation, and swelling in the heel. Treatment includes rest, ice, and medication, but severe cases may require surgery. The Achilles tendon is responsible for transferring force from the calf muscles through the ankle to produce plantar flexion, and is critical for walking, running, jumping, and climbing movements. Overuse of the tendon can cause an inflammatory condition known as retrocalcaneal bursitis that often accompanies insertional Achilles tendonitis.
Insertional Achilles tendonitis is a condition that involves the gradual degradation of the Achilles tendon where it meets the heel bone of the foot, better known as the heel bone. This form of tendonitis, which causes pain, inflammation and often swelling in the heel, is common in older people who participate in repetitive activities such as running, particularly among overweight people. Most cases of insertional Achilles tendonitis can be treated like any inflammatory condition with a combination of rest, ice, and medication, but more severe cases may require surgery to remove damaged portions of the tendon.
Actually made up of the tendons of the gastrocnemius, soleus and plantaris muscles of the calf, the Achilles tendon is the strongest tendon in the human body. It originates where these muscles converge on the back of the ankle and cross the talocrural, or ankle, and subtalar joints to insert along the middle third of the posterior surface of the calcaneus. The Achilles is responsible for transferring a large amount of force from the calf muscles through the ankle to produce plantar flexion, or the downward hinge of the foot at the ankle joint, and as such is critical for walking, running, jumping and climbing movements. Because this tendon is heavily used, however, it is susceptible to degenerative injuries such as insertional Achilles tendonitis.
The Achilles tendon is separated from the rough bone surface of the heel bone by the retrocalcaneal bursa, which is a sac of synovial fluid that cushions between the tendon and bone. Overuse of the tendon can cause an inflammatory condition known as retrocalcaneal bursitis that often accompanies insertional Achilles tendonitis. This is due to a shortage of blood vessels supplying the tendon, meaning any degradation of the tendon or surrounding tissue can take time to heal without receiving the nutrients supplied by the blood. As a result, overuse of the Achilles can make it vulnerable to further failure.
This condition causes pain where the tendon meets the heel bone during and after exercise and swelling of the heel from edema and/or enlargement of the injured tendon. Stiffness behind the ankle joint may also be reported. It is recommended that people experiencing these insertional Achilles tendonitis symptoms see a doctor, who will likely suggest the RICE method of treatment for mild to moderate cases. This treatment includes resting the injured area, applying ice, compressing the ankle with a sling or shoe insert to reduce the aggravation of the injury, and elevating the foot, as well as taking pain relievers to treat the inflammation . More severe cases may require surgery to remove portions of the injured tendon, as well as any accumulated calcifications or calcium salts that harden the tissue, which have developed at the site of the injury.
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