Insertional Achilles Tendonitis

The largest tendon in the body is called the Achilles tendon. It is a tendon that joins your calf muscles to the heel bone. The Achilles tendon comes into play whenever you run, jump or walk and can take a great deal of stress during any of these activities. It can also contract Achilles tendonitis which is from overusing it too much. It results in pain that runs from the back of the leg all the way down to the back of the heel.

What Is Insertional Achilles Tendonitis?

Insertional Achilles tendonitis is the result of damaged tendon fibers that occur at the bottom of the foot around the heel where it looks like the tendons are inserted into the bone of the heel. These damaged tendons can calcify or harden and bone spurs could result. Insertional Achilles tendonitis can happen anytime, even when you are not active.

Some of the symptoms are:

• Swelling in the heel area that gets worse as the day goes on
• Extreme pain the next day after you exercised
• Stiffness and pain in the Achilles tendon when you first get up
• The tendon thickens up
• A bone spur
• Pain behind your heel or around the tendon which gets worse as you walk on it

Why Does It Happen?

Achilles tendonitis is usually the result of putting too much stress in a repetitive manner on your feet. It can be caused by other things as well, such as:

• If you increase your exercise levels too quickly without giving your feet a chance to adjust.
• If your calf muscles are tight and you don't give them a chance to relax
• If you develop a bone spur which is extra bone that grows near the tendon. If the spur rubs against the tendon it can cause tendonitis

How to Manage Insertional Achilles Tendonitis

There are ways of treating the condition that do not require a surgical procedure. Any of the following approaches may help:

• Using a shoe that has a moderate heel or adding a heel lift in your shoe. When you walk in shoes that are flat or go barefoot you are putting more tension on the inserted Achilles tendon. Providing a lifted heel can evenly distribute the weight that is put on it and relieve the stress.
• Calf stretching – Our calves have to endure repetitive wear and tear because of all the walking and standing that we do on a regular basis. Stretching your calves can help to lengthen the Achilles tendon as well as making it more compliant.
• Nonsteroidal anti-inflammatories [NSAIDs] – While NSAIDs help to relieve the pain they do not do anything to help heal the problem. If you have any problems with your stomach, have heartburn or an ulcer, you should not take NSAIDs. You should stay away from them if you have heart problems as they have been known to contribute to cardiovascular disease as one of their side effects.
• Weight loss – An easy way to help relieve the pain from this type of tendonitis is to lose weight. Your body has to endue many times your body weight on a regular basis, so losing just 5 to 10 pounds will help relieve excess pressure.
• Cast or walker boot – Keeping a boot or cast on for 4 to 8 weeks will help give the tendon time to heal. You should find out the initial cause so you can prevent it from happening again.

Operative Treatment

If there has been no improvement after several months surgery may be necessary. A procedure may be required to remove the parts of the tendon that are degenerating as well as a bone that may be irritating the tendon or bursa tissue that may be inflamed. A short tendon may also be addressed during surgery. If a tendon is attached to the bone it could be strengthened by attaching it right to the bone with sutures.

There are several different treatments that may be used to achieve these results. None is better than another, so it depends more on the patient regarding their health history, age, and the status of the situation at hand. If over 50 percent of the tendon has been removed, doctors will have to take one of the tendons that are behind the ankle and move it to the bone on the heel so that the Achilles tendon is strong enough and there is a solid supply of blood to the area

One of the procedures that should be followed after surgery includes wearing a toe-down splint for a couple of weeks so that the area can heal. When the healing has begun to show signs of improvement a cast or brace can be worn and additional exercises can begin. At four to six weeks physical therapy can be started and regular activities can start up again in 8 to 12 weeks. The chances for an excellent recovery after surgery are about 75 percent.

Can It Be Prevented?

It may be impossible to prevent another bout of insertional Achilles tendonitis but there are some things you can do to cut down on getting it again.

• Stay active – Start out slowly but keep moving forward until you are back at the activity level you were at previously.
• Pace yourself – If you are going to resume strenuous activities again make sure that you take it slow in the beginning and rest when you need to. Don't overdo it.
• Stretch it out – Stretching out your calf muscles and the Achilles tendon will help keep you supple enough to stay flexible and avoid additional injuries.
• Vary your routine – Don't just keep to the same activity; try other things such as biking, swimming, and running. Low impact exercises such as riding on a stationary bike are also good ways to get in your daily exercise without continuing the same routine as before.