Those who suffer from heel pain are often affected by a disorder of the Achilles tendon. 

There are many possible causes for this pain, such as:

  • Safety shoes.
  • Shoes with hard soles that are unsuitable for one’s feet.
  • Activities that require spending many hours standing. 

The pain can sometimes be associated with the appearance of a hump on the heel, and in these cases wearing shoes might become really difficult.

Achilles tendon insertional tendinopathy: Symptoms

Pain in the heel, the appearance of a “hump,” and discomfort when putting on shoes – but also in keeping them on your feet – are symptoms of insertional tendinopathy of the Achilles tendon, which is where the tendon inserts on the heel.

This area includes several structures (such as retroachilles bursa, calcaneus, and soft tissues) surrounding the Achilles tendon. Due to the mechanical stress of the tendon rubbing on these structures, it can become inflamed.

The rubbing then increases due to socks and shoes. For this reason, insertional tendinopathy of the Achilles tendon especially affects those who wear hard shoes for work or a long time, increasing friction.

The orthopedic examination for diagnosis

A specialist orthopedic examination is essential to determine the appropriate therapy based on the extent of the problem. 

Although the risk of Achilles tendon rupture in these cases is low, it is still important to assess the problem clinically. 

Achilles tendon insertional tendinopathy: Treatments

When conservative treatments with shock waves or Tecar therapy are ineffective, minimally invasive surgical therapies can be performed to eliminate the conflict due to the heel rubbing on the tendon and resolve the pain. 

Surgical therapies can be endoscopic – through small holes at specific points in the tendon, which is only possible in cases without intratendinous calcifications – or with intratendinous median incision. 

The intratendinous midline incision is one of the most widely used because it innovatively allows the removal of the calcaneus portion that causes the problem without disconnecting the tendon from the calcaneus itself. 

The surgery can be performed in day-hospital or with one night of hospitalization. Full load can be achieved after 4 weeks of using crutches and with support on the arms and the contralateral limb. For athletes, however, resumption of any competitive sports activity will have to wait 4-6 months after surgery.