The repetitive pull of the Achilles tendon on its attachment to the calcaneus or heel bone can sometimes be a source of pain. If you are an avid runner, over the age of 40, and have heel pain in your Achilles tendon, you may be prone to developing an insertional Achilles tendinitis. Typically this condition presents as a prominence or swelling at the insertion (attachment) of the Achilles tendon. Anatomically, two typical abnormalities will present themselves in the development of Achilles insertion pain:
(1) A retrocalcaneal bursitis – inflammation of the bursa between your heel bone and Achilles tendon.
(2) Haglund’s deformity or retrocalcaneal exostosis– a small upward projection of bone on top of the heel bone near the Achilles attachment.
Most runners describe the pain and swelling as gradual, which is worse while exercising and running. Repetitive stress and mechanical strain are the main culprits in development of symptoms. Factors which will likely make you at increased risk of developing an insertional-type Achilles condition include: male gender, various types of systemic arthritis, diabetes, corticosteroid injections, and antibiotics such as fluoroquinolones (which have been linked to tendon damage/rupture).
Diagnosis:
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Clinical exam
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X-ray
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Ultrasound
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MRI
Treatment:
Initial conservative treatment includes: non-steroidal anti-inflammatory drugs (NSAID’s), ice, rest, and heel lifts. If continued pain, laser therapy, physical therapy, orthotics, casts/braces, and night splints have shown to be beneficial. As with many pathologies linked with running, replacing running shoes that have excessive mileage can also mitigate symptoms.
Surgical options for insertional Achilles considered when conservative options have failed and may involve tendon repair or resection of bone spurs at the attachment of the tendon.
As this condition is better treated early in its development, please contact us at 406-721-4007 if you are experiencing these symptoms.