Insertional Achilles Tendinosis

Tendon degeneration is the breakdown of the fibers of the achilles tendon at its insertion point. This develops gradually over time due to repetitive stress or mechanical overload, causing microscopic tears that accumulate and result in a painful tendon. Aging may play a part, but playing running and jumping sports can cause repetitive trauma that can lead to tendinosis

Unlike tendinitis, which involves pain and swelling, tendinosis is a chronic condition caused by the deterioration of the tendon. This distinction is essential for understanding the long-term nature of the condition and the focus on tendon repair and strengthening in treatment plans.

Patients with insertional achilles tendinosis typically experience a range of symptoms that can progressively worsen without appropriate management. Common symptoms include:

• Heel Pain: Pain at the back of the heel is the hallmark symptom. This pain is usually worse in the morning or after periods of inactivity and may increase with physical activity.
• Stiffness: Stiffness, especially in the morning or after prolonged sitting, is common. This stiffness can limit the range of motion in the ankle.
• Reduced Strength and Function: As the condition progresses, patients may experience weakness in the calf muscles and difficulty performing activities that require pushing off the foot, such as climbing stairs or sprinting.
• Bone Spurs: In some cases, bone spurs may develop where the tendon attaches to the heel bone.

• Diabetes
• High blood pressure
• Obesity
• Hormone replacement
• Contraceptives

Insertional achilles tendinosis can be attributed to several factors, often involving a combination of biomechanical, lifestyle, and age-related influences. The most common causes include:

• Repetitive Stress and Overuse: Athletes and individuals who engage in high-impact activities, such as running and jumping, are at increased risk due to repetitive stress on the tendon.
• Improper Footwear: Poorly fitting or unsupportive shoes can contribute to abnormal stress on the Achilles tendon, accelerating tendon degeneration.
• Calf Tightness: Tight calf muscles place additional strain on the Achilles tendon, making it more susceptible to injury and degeneration.
• Age and Degeneration: The risk of insertional Achilles tendinosis increases with age as tendons naturally lose elasticity and strength over time.
• Biomechanical Factors: Abnormal foot mechanics, such as flat feet or high arches, can alter the distribution of force on the Achilles tendon, increasing the risk of tendinosis.
• Sudden Increase in Activity: Rapid escalation in physical activity without adequate conditioning or warm-up can overload the tendon, leading to microtears and degeneration that can eventually lead to tendon rupture.

A thorough evaluation by an orthopedic specialist like Dr. Boden is crucial for accurately diagnosing insertional Achilles tendinosis. The diagnostic process typically involves the following steps:

Patient History

A detailed discussion of the patient’s symptoms, activity levels, and potential injury triggers helps identify patterns indicative of tendinosis.

Physical Examination

The examination focuses on assessing pain, tenderness, swelling, and the range of motion of the ankle. Dr. Boden may also evaluate calf muscle strength and observe gait patterns.

Imaging Studies

• X-rays: X-rays can reveal calcifications, bone spurs, or abnormalities in the heel bone that may contribute to pain.
• Ultrasound: This imaging modality provides a real-time assessment of the tendon, allowing for the identification of tendon thickening, tears, or fluid accumulation.
• MRI (Magnetic Resonance Imaging): MRI offers detailed visualization of the soft tissues, enabling the detection of tendon degeneration, partial tears, and inflammation around the tendon.

Accurate diagnosis is essential for tailoring a treatment plan that addresses the severity of the condition and the patient’s activity goals.