One of the more common sources of heel pain, after plantar fasciitis, is Achilles tendinitis. This can be from an overuse injury when the Achilles tendon is subjected to excessive force, but it can also be the result of a tightened calf muscle tugging on the tendon. No matter the cause of your Achilles tendinitis, you will experience pain and swelling in the back of the heel as the result of the condition. Fortunately, you can always come see us here at the office of Jeffrie C. Leibovitz, D.P.M. for the effective care and treatment you need.
Insertional Achilles Tendinitis
This particular injury is from a degeneration of the normally-durable fibers of the Achilles tendon at the point where it attaches into the heel bone (calcaneus). It can be associated with an inflamed bursa at the back of the heel. The bursa acts as an airbag to reduce the repetitive impact from the shoe. A callus or thickened tissue can also develop in this area.
Your Achilles tendon is the largest and strongest tendon
s in your body. It is formed by the merging of your upper calf muscles. These tendons function to bend your knees, point toes downward, and even slightly roll the heel. This strong and robust tendon connects into the back of the heel bone.
If this becomes a chronic problem the bone will enlarge and develop a “shelf” extending at the back of the heel bone which we refer to as a Haglund’s deformity or “Pump Bump”. This appears as swelling where the back of the shoe hits the heel. With a dress heel or pump, the shoe is impacted against this area with greater force.
We find that most patients report a gradual onset of both pain and swelling at the point where the Achilles tendon inserts into the heel bone, without being able to identify a specific injury. The pain is initially described as appearing after activity, but becomes more constant over time. The pain in the back of the heel worsens during high-impact activities like running and jumping, and especially in athletic activities where sprints are used. Symptoms will also flare after wearing a shoe with a curved or rigid heel counter like a penny loafer or women’s dress heel.
There is an increased risk of Achilles damage for those who have psoriasis and other inflammatory soft tissue diseases, or use medications like fluoroquinolone antibiotics or corticosteroids.
To properly diagnose the condition, we may need to use x-rays to determine if there are calcification deposits in the area where it inserts into the heel or if the changes are from limited to soft tissue. Ultrasound imaging can be used instead of MRI to see the extent of the tendon’s degeneration, and if there are other factors contributing to the posterior heel pain (like bursitis).
Conservative treatment is generally quite effective in the majority of patients in the early stages. This can entail the use of stretching exercise, nonsteroidal anti-inflammatory drugs, orthotics or heel lifts, and footwear that does not place excess pressure on the area. In the event symptoms persist, we may prescribe night splints or physical therapy. As a last resort we may need to immobilize the leg with a removable brace or cast.
Surgical treatment may be a recommended option if nonsurgical treatment has not provided sufficient relief after several months. Surgery can be used to remove the degenerative portions of the Achilles tendon, any inflamed bursa tissue, and any bone irritating the tendon. If the tendon is short, then a procedure to provide additional length may be required. Depending on the patient, the tendon will be re attached to bone with an anchor technique that allows a quicker return to walking.
For more information on insertional Achilles tendinitis, or to schedule an appointment for treatment to take away that pain in the back of the heel, simply give our Indianapolis, IN office a call at (317) 545-0505.