Non-Insertional Achilles Tendinopathy

Are you an athlete? Do you have achilles tendon tightness and pain when you first get out of bed to walk in the mornings? Do your achilles burn slightly behind your ankles when you run on uneven pavement? Are your calves tight? If you answered ‘yes’ to any of these questions then there’s a possibility that you may have non-insertional achilles tendinopathy (tendinitis). Read the information below for more details.

What is non-insertional achilles tendinopathy (tendinitis)?

● Small tears in the middle fibers of your tendon start to break it down.
● This type of tendonitis usually affects active, younger adults
● Athletes, particularly middle and long distance runners, are the most common group affected by non-insertional achilles tendinopathy.
● The most common condition affecting the achilles tendon.
● Degenerative condition that causes pain on activity.
○ Area of degeneration occurs between 2 cm to 6 cm from the insertion of the achilles into the calcaneus.

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

Assessment

● 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

Treatment

● 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.

Recovery

● 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.