Insertional Achilles Tendinopathy with Calcaneal Spur
Diagnosis
- The American Academy of Family Physicians notes that insertional Achilles tendinopathy is characterized by insidious onset of chronic posterior heel pain and swelling at the Achilles insertion site, with pain worsening with activity and shoe pressure, but improving when walking barefoot 1
- Radiographs show spurring or erosion at the Achilles insertion, representing a degenerative condition (tendinosis), not acute inflammation (tendinitis), with chronic degenerative changes and collagen disorganization 1, 3
Initial Conservative Treatment (First 6-8 Weeks)
- The American Academy of Family Physicians recommends initial treatment consisting of open-backed shoes, heel lifts, eccentric strengthening exercises, calf stretching, NSAIDs for acute pain, and activity modification, avoiding corticosteroid injections due to rupture risk 1, 2
- Eccentric strengthening exercises of the gastrocnemius-soleus complex have the strongest evidence for effectiveness 2
- NSAIDs are recommended for acute pain relief only, as this is a degenerative condition, not inflammatory 1, 2
Critical Pitfall to Avoid
- The American Academy of Family Physicians advises against injecting corticosteroids into or around the Achilles tendon insertion, as it inhibits healing, reduces tensile strength, and significantly increases the risk of tendon rupture 1, 2, 4