Are you an athlete with tight calf muscles when you start exercising? Does your heel(s) hurt when you walk, run, or wear the wrong shoes? Are your achilles tendons tight after resting for long periods of time? Do you have pain when you run on uneven surfaces? If you answered ‘yes’ to any of these questions, then you may have insertional achilles tendinitis. Read the information below for more information.

What is insertional achilles tendonitis?

● Insertional achilles tendinitis involves the lower portion of the tendon, where it attaches to the heel bone (calcaneus).
● Tendonitis is due to overuse or damage to the tendon.
● It can cause pain down the back of your leg and around your heel.
● This damage occurs in the spot where your tendon meets your heel bone.
● Bone spurs (extra bone growth) often form.
● This type of tendonitis can happen at any age, even in people who are not active.

Personal Injury Causes

● Training errors
● Steroids
● Fluoroquinolones (an Antibiotic)
● Increased amount or intensity of an activity or sport
● Starting a new sport
● Tight calf muscles when starting an exercise or sport, this can place more stress on your tendon
● Bone spurs on your heel, which can rub against the tendon
● Wearing the wrong shoes when you exercise
● Exercising on an uneven surfaces

Signs and Symptoms

● Pain at the most intense when moving after a period of rest
● Pain and stiffness along the Achilles tendon in the morning
● Pain along the tendon or back of the heel that worsens with activity
● Severe pain the day after exercising
● Thickening of the tendon
● Bone spur formation (insertional tendinitis)
● Swelling that is present all the time and gets worse throughout the day or with activity
● Pain on the back of the heal when you wear shoes


● Patients will present with pain and swelling on the the posterormedial side of the tendon and tenderness at the site.
● Magnetic resonance imaging (MRI) scans can help identify the nature, location and extent of a lesion.
● Ultrasound used in conjunction with a Doppler sonography since the pain in Achilles tendinopathy seems to be related to areas of neovascularisation.
○ It has been shown that new, pain transmitting nerve endings (neonerves) grow into the tendon with the new vessels, and those treatment modalities which reduce the amount of neovascularisation can lead to a reduction in symptoms


● Conservative treatment:
○ Eccentric stretching (exercises designed to both stretch and strengthen the Achilles tendon) being the safest, cheapest and most effective modality which should therefore be the first line of treatment.
○ Avoiding aggravating activities
○ Use of a slight heel lift inside the shoe
○ Wearing a shoe with a heel to off-load the tendon
○ Anti-inflammatory medications (if tolerated)

● Surgery:
○ For patients who fail conservative treatment,
○ Surgery usually requires removal of the damaged tissue (debridement) and meticulous repair of the tendon.


● Patient compliance and postoperative management are important factors in preventing ankle stiffness or recurrence of the symptoms.
● Postoperative immobilization is required, followed by the gradual introduction of range of motion and strengthening exercises.
● It may require 6 months to achieve full recovery.
● Some known complications are recurrence, stiffness of the ankle, and deep vein thrombosis.

Figure 1: Medical illustration of the symptoms of Achilles tendonitis or inflammation of an Achilles


John Hopkins Medicine. (2022). Achilles Tendon Injuries.

Massachusetts General Hospital. (2022). Achilles Tendonitis.

Rob9000. (2022). [Illustration]. Medical illustration of the symptoms of Achilles tendonitis or
inflammation of an Achilles tendon.

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