Insertional Achilles Tendonitis

Insertional Achilles Tendonitis – Its Definition And Treatment


Insertional Achilles tendonitis is defined as a degeneration of those fibers of the Achilles tendon that are located where the tendon is inserted into the back of the heel bone. The shape and size of the back of the heel bone can vary somewhat from person to person. If there is any kind of a protrusion in the heel bone that comes close to the Achilles tendon, or actually comes into contact with the tendon, the rubbing of bone against tendon can eventually lead to irritation and tissue degeneration.

The tendons in the body serve to connect muscle to bone. Most of the tendons in the body are protected by a sheath. This sheath serves to keep the tendons from rubbing against the hard surfaces of bones. The Achilles tendon, which connects the upper calf muscle to the heel bone, has no such sheath. There is some protective tissue, but that tissue can easily break down in the vicinity of the heel bone if the tendon comes into constant contact with the bone.


Tendonitis And Its Treatment


Tendonitis is defined as an inflammation of a tendon. In this case, although inflammation is present, it is accompanied by an actual degeneration of some of the fibers that make up the tendon. In most cases, the only treatment that is required is the use of anti-inflammatory medication (non-steroidal), coupled with mechanical fixes, such as heel lifts or special shoes. The mechanical fixes are necessary because the anti-inflammatory drugs, while addressing the inflammation problem, do not address the source of the problem. In the past, there have been occasions where Insertional Achilles tendonitis has been treated with cortisone injections. While such injections have often provided temporary relief, they have at the same time caused damage to the tendon, making it weaker, and more subject to being ruptured. There have even been cases where cortisone injections have resulted in the death or partial death of the Achilles tendon.

Tendinopathy – A More General Term


Insertional Achilles tendonitis is sometimes referred to as insertional Achilles tendinopathy. Tendinopathy is a more general term. It means a disease in a tendon. Tendonitis is of course a disease affecting the tendon, as is tendinosis and bursitis, the latter often occurring in tandem with tendonitis.


One of the peculiarities of the Achilles tendon is that it has a rather weak blood supply. Having a weak blood supply makes the tendon slower to heal than is the case with most of the other tendons in the body, and it also makes the tendon weaker during the healing process, which is one reason why the recovery time required when an Achilles tendon has been injured can be a lengthy one. When in a weakened condition, either due to a previous injury or due to a disease such as insertional tendonitis, the Achilles tendon is more susceptible to being ruptured.


While the tendon itself, which consists primarily of collagen,  is somewhat lacking in blood vessels, a single layer of cells, called the paratenon which is quite rich in blood vessels, wraps around the tendon, helping to nourish it during the healing process.

A Large, Strong Tendon – But Subject To Punishment


Many are of the belief that the Achilles tendon is a rather small tendon in the ankle, a tendon that is located just above the heel. As noted above, the tendon attaches to the calf muscle, which is fairly high up on the lower leg. However, the symptoms of a weakened or inflamed Achilles tendon are most likely to be felt just above the heel, which also happens to be the location where a rupture is most likely to occur. Still, for all of the problems it can encounter, the Achilles tendon is the largest and strongest tendon in the body. By the same token, it undergoes more stress and strain, and more wear and tear, than any other tendon in the body. Runners account for the majority of Achilles tendon problems or injuries, possibly extending to cases of insertional tendonitis, although its root cause is more due to a person’s heel bone configuration.


Exercises designed to strengthen the Achilles tendon is another important approach to treating an insertional tendonitis problem. The exercise most frequently recommended involves stretching the tendon by rotating the ankle while standing on tip toes. This exercise serves to strengthen the frontward facing portion of the tendon, but it should not be confused with heal lifts, which while strengthening the calf muscles, do little to strengthen the tendon, and can actually have the opposite effect if the tendon has become weakened.


The best approach to treating a case of insertional Achilles tendonitis is to utilize the services of a physician, and perhaps later, of a personal trainer who hopefully is familiar with treating this particular disorder. In some instances surgery may be required to resolve the problem once and for all, especially if the configuration of the heel bone is such that the problem is likely to repeat.




In summary, insertional Achilles tendonitis is a disease occurring where the tendon is inserted into the heel bone, it is the Achilles tendon that is involved and the disease itself is characterized by the inflammation of the tendon, tendonitis.