Insertional Achilles Tendonitis
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Insertional Achilles Tendonitis causes pain in the lower part of the Achilles Tendon as it attaches to the heel bone and it affects up to 9% of recreational runners.
The most effective form of treatment for Insertional Achilles Tendonitis is graded strengthening exercises under the guidance of a Physical Therapist. Heavy slow resistance training that includes weighted heel raises from a neutral position should be performed 3 times a week for a 12-week period. This form of rehabilitation has the strongest medical evidence for the treatment of Insertional Achilles Tendonitis.
These exercises may be complemented by other forms of treatment, such as shockwave therapy, anti-inflammatories, heel raises and insoles.
Strengthening exercises should be progressively difficult, and while some pain during the exercise protocol is acceptable, this pain should subside within 24 hours.
All forms of treatment for Insertional Achilles Tendonitis should be under the guidance of a Physical therapist to ensure you are carrying out the best exercises at the right stage of your recovery.
Insertional Achilles Tendonitis typically takes 6-12 weeks to recover from.
In the acute phases, it may be too painful to do anything apart from the rehabilitation exercises set by your Physical Therapist. During this phase, you can carry out a mixture of non-impact exercises, such as swimming or cycling, to maintain your cardiovascular fitness. A short break from impact activity for 10 days can help your pain levels decrease quickly.
As you move into weeks 2-6, your rehabilitation exercises will become more difficult, and you can discuss with your therapist the best way to reintroduce impact activity.
As the tendon becomes stronger between weeks 6-12, you should be able to increase your general activity levels without fluctuations in Achilles Tendon pain.
It is very important to work closely with a Physical therapist and not stop your rehabilitation early because you have reduced pain levels. Insertional Achilles Tendonitis causes a change in the structure of the tendon and if it is not fully rehabilitated, then the symptoms are likely to return.
There is currently no evidence to suggest that compression socks are effective for treating Insertional Achilles Tendonitis.
Compression socks are tight socks that you wear around your calf muscle to compress the calf and increase blood flow to the area.
They are commonly used by long-distance runners to reduce calf pain when running and to help with recovery post-exercise. The theory is that compression reduces lactic formation.
Still, there is limited evidence for this, and in fact, one paper highlights that compression socks may be a risk factor for developing Insertional Achilles Tendonitis.
Stretching is not recommended for treating Insertional Achilles Tendonitis.
The Achilles Tendon attaches the calf muscle group to the heel bone, and as it wraps around the back of the heel bone, there is a compression point between the tendon and the bone.
When stretching the Achilles Tendon, it compresses the tendon against the heel bone, resulting in greater pain. Therefore, it is not recommended to stretch Insertional Achilles Tendonitis.
We recommend strengthening exercises to alleviate your Insertional Achilles Tendonitis pain and using heel raises inside your shoes.
If you have persistent Achilles Tendon pain, we recommend a consultation with a foot and ankle specialist.
Insertional Achilles Tendonitis is a relatively common condition.
A study by Waldecker et al, 2012. of 1394 people in the general public, Achilles Tendonitis was found in 5.6%% of the population, while 4% of those had Insertional Achilles Tendonitis. In the sporting population, Achilles Tendonitis was found in 9% of recreational runners.
Continuing to run with Insertional Achilles Tendonitis is possible, but caution is advised to prevent further injury or complications.
Insertional Achilles Tendonitis affects the lower aspect of the Achilles tendon as it attaches to the heel bone. This attachment point has less blood flow compared to the mid-portion and experiences compression against the heel bone, making continued running challenging.
Running with Insertional Achilles Tendonitis can cause increased pain levels; however, stopping running altogether may lead to deconditioning of the Achilles tendon, making it more difficult to return to running. The general principle is that it is acceptable to experience some pain in the Achilles tendon while running as long as this pain subsides within 24 hours of your run. If the pain persists beyond this timeframe, consider reducing your distance or pace during your next run.
To effectively manage Insertional Achilles Tendonitis while running, it is important to follow a carefully designed training plan that allows for progressive loading of the tendon while minimizing the risk of further injury. Here is an example of what a running programme with Insertional Achilles Tendonitis may look like:
Weeks 1-2: Pain management and initial rehabilitation with reduced running. During this phase, continue running but allow at least 48 hours between runs at a steady pace. Monitor pain levels the morning after a run, and consider reducing your running volume if you experience higher pain levels than normal. In this stage, the patient should begin isometric strengthening exercises for the calf muscles to help maintain and develop strength.
Weeks 3-4: Gradual return to running. Begin increasing the duration of your runs, starting with short distances at a slow pace and gradually increasing the duration by no more than 10% per week. Alternate between running and walking to reduce the stress on the tendon. In this stage, the patient should carry out isotonic calf and Achilles strengthening exercises to build strength and resilience in the tendon and surrounding muscles.
Weeks 5-8: Progressive loading and running. Increase running intensity by adding hill work or gradually increasing your pace while monitoring pain levels. Slowly add longer runs to your training schedule, adhering to the 10% rule for weekly volume increases.
Weeks 9-12: Return to regular training. Gradually return to your normal running routine, ensuring you maintain a balance between intensity, volume, and recovery. Incorporate cross-training activities, such as strength training, swimming, or cycling, to maintain your cardiovascular fitness.
It is essential to follow a comprehensive treatment plan, which may include physical therapy, strengthening and stretching exercises, and anti-inflammatory medications. Consult a medical professional, such as a Physical Therapist, to develop an appropriate plan tailored to your specific needs. They can guide you in managing your condition while running and help you make necessary modifications to your routine to minimize the risk of further injury.
In summary, while it is possible to continue running with Insertional Achilles Tendonitis, it is crucial to exercise caution and work closely with a healthcare professional to develop a personalized treatment plan to ensure a full recovery.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments weekly.