Understanding Achilles Tendinopathy: Midportion vs. Insertional
Achilles tendinopathy is a common podiatric condition characterised by pain, swelling, and reduced function of the Achilles tendon. This degenerative condition results from overusing the tendon or repetitive stress, leading to micro-tears in the Achilles tendon.
It can be divided into two main types: midportion Achilles tendinopathy and insertional Achilles tendinopathy. Both midportion and insertional Achilles tendinopathies are treated differently.
Midportion Achilles Tendinopathy
Location: Occurs in the middle section of the Achilles tendon at the back of the leg, about 2-6 cm above the back of the heel bone.
Symptoms:
Pain and stiffness in the middle of the tendon.
Swelling in the affected area.
Pain that increases during and after physical activity.
Morning stiffness that improves with movement.
Causes:
Overuse and repetitive stress from activities like running and jumping.
Sudden increase in physical activity or training intensity.
Poor footwear or running on hard surfaces.
Treatment:
Rest and Activity Modification: Reducing activities that cause pain.
Eccentric Exercises: Exercises that strengthen the tendon and promote healing.
Physical Therapy: Includes stretching, strengthening exercises, and manual therapy.
Pain Management: Use of ice, anti-inflammatories, and other pain relief methods.
Orthotics: Custom devices to support the foot and reduce stress on the tendon.
Advance therapies: if conservative management fails, shockwave therapy and prolotherapy can be explored to help heal the tendon.
Insertional Achilles Tendinopathy
Location: At the attachment of the Achilles tendon to the heel bone.
Symptoms:
Pain at the insertion point.
Swelling and thickening of the tendon at the insertion.
Heel pain that worsens with physical activity or certain shoes.
Tenderness and difficulty flexing the foot up and down.
Causes:
Chronic overuse, especially with tight calf muscles.
Bone spurs that develop at the insertion point, irritating the tendon.
Poor foot mechanics or improper footwear.
Treatment:
Rest and Activity Modification: Avoiding activities that worsen the pain.
Heel Lifts: Using heel lifts to reduce tension on the Achilles tendon.
Stretching and Strengthening Exercises: Improving flexibility and strength in the calf muscles and tendon.
Physical Therapy: Various modalities to reduce pain and inflammation.
Shockwave Therapy: A non-invasive option to stimulate healing.
Prolotherapy: injections of a natural irritant for long-term healing and pain relief.
Surgery: In severe cases, surgery may be needed to remove bone spurs or damaged tissue.
Preventive Measures
Proper Footwear: Wearing shoes with good support and cushioning.
Gradual Increase in Activity: Slowly increasing the intensity and duration of physical activities.
Regular Stretching: Keeping the calf muscles flexible to reduce strain on the tendon.
Strength Training: Incorporating exercises to strengthen the calf muscles and tendon.
Conclusion
Achilles tendinopathy, whether midportion or insertional, requires careful diagnosis and targeted treatment for effective recovery. Understanding the differences and treatment approaches for each type helps individuals manage their condition and return to regular activities with minimal discomfort.
If you are experiencing symptoms of Achilles tendinopathy, book in with one of the podiatrists JS Podiatry for a personalised treatment plan tailored to your goals.
