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Orthopaedic Specialties

Achilles Tendinitis – Achilles Calcific Insertional Tendinopathy

Achilles Insertional Calcific Tendinopathy, also known as the Insertional Achilles Tendinitis, is a condition triggered by the degeneration of the Achilles tendon in the heel that produces bone spurs. Achilles Insertional Calcific Tendinopathy can cause heel pain in active and inactive people and can be intensified by activity or footwear. Generally, it takes many years for Achilles Insertional Calcific Tendinopathy to arise. There are many treatment options available for a return to daily life.

Achilles Tendonitis

Anatomy – Achilles Tendinitis

The Achilles tendon is a durable, fibrous band of tissue that attaches the calf muscle to the heel bone. As the calf muscles flex, the Achilles tendon tugs on the heel, permitting you to walk, climb stairs, run, jump, and even stand on the tip of your toes. The Achilles tendon is the biggest in the body. Even though it is the strongest, it is also susceptible to injury because of its reduced blood supply and the high forces placed upon it.

Description – Achilles Tendinitis

The Achilles tendon continually undergoes stress. If the tendon does not enough time to recover, microscopic tearing begins to ensue. Gradually, the damaged tendon fibers start to calcify, often creating bone spurs. This degeneration and calcification is known as Achilles Insertional Calcific Tendinopathy. Achilles Insertional Calcific Tendinopathy can occur in both active and inactive patients and is not linked to a specific injury. It comes from years of overuse. For instance, runners who run long distances and sprinters are both known to suffer from Achilles Insertional Calcific Tendinopathy. It can cause heal pain and can be aggravated by activity or footwear. Additional factors resulting in Achilles Insertional Calcific Tendinopathy include:

  • A rapid increase in the intensity or amount of exercise activity. Such as someone who increases the distance run every day by a few miles without giving their body a chance to adjust to the new distance.
  • Having tight calf muscles and starting an aggressive exercise program can put extra stress on the Achilles tendon.

Achilles Tendinitis Symptoms

Common symptoms of Achilles Insertional Calcific Tendinopathy include:

  • Pain and stiffness along the Achilles tendon that gets worse when performing activities. The pain and stiffness are usually felt in the morning.
  • Bone spurs.
  • Acute pain the day after exercising.
  • The tendon becomes very thick feeling.
  • Swelling that worsens throughout the day upon activity.
  • Abrupt popping sound coming from the back of the calf or heel.

Diagnosis of Achilles Tendinitis

The Orthopaedic physician will examine your ankle and foot, looking for the following symptoms:

  • Swelling along the Achilles tendon or at the back of the heel.
  • Bone spurs at the lower part of the tendon at the back of the heel.
  • Thickening of the Achilles tendon.
  • Pain at the back of the heel at the lower part of the tendon.
  • Location of the most significant soreness.
  • Limited range of motion, especially a decreased ability to flex the foot.

Treatment Options

Available treatment options depend on the seriousness of an injury. Several non-surgical options are available, but surgery may be necessary if the pain does not markedly improve within six months. Surgical options are based on how much damage has occurred to the Achilles tendon.

Non-surgical Treatments

In most cases, non-surgical treatments can deliver pain relief, although it may take a few months for symptoms to decrease. The duration of recovery is contingent on the severity of the injury. The following non-surgical treatments can help the healing process:

  • The first step is to reduce pain and allow yourself to rest. Stop all activities that cause pain. Try low-impact exercises that don’t produce stress on the Achilles tendon
  • Icing the area can help with pain management and can be performed throughout the day for up to 20 minutes per session and should be discontinued if the skin becomes numb.
  • Non-steroidal anti-inflammatory medications such as Advil and Aleve can help to reduce swelling and pain.
  • Exercises that strengthen the calf muscles can also reduce stress on the Achilles tendon.

Non-surgical Therapies

Non-surgical treatments should be attempted first to see if the pain decreases.

  • Extracorporeal Shockwave Therapy – High-energy shockwave impulses can stimulate healing in injured tendon tissue.
  • Cortisone Injections – Cortisone is a powerful steroid that works as an anti-inflammatory and often helps control the swelling caused by Achilles Insertional Calcific Tendinopathy.

Surgical Treatments

Surgery should only be considered after six months of no improvement with non-surgical treatments. This procedure is dependent on the location of the tendinitis and the amount of damage to the tendon. The surgical treatments used to correct Achilles Insertional Calcific Tendinopathy include:

  • Debridement and repair (if the tendon has less than 50% damage). The objective of this surgery is to remove only the damaged portion of the tendon. Once the damaged section is removed, the remaining portion of the tendon is repaired, and the bone spurs are removed. Within a few weeks after the surgery, most patients are permitted to walk in a removable boot or cast.
  • Gastrocnemius recession. Because tight calf muscles produce extra stress on the Achilles tendon, the calf (gastrocnemius) muscles are lengthened during this surgery to improve the ankle’s motion.

Your Orthopaedic Associates of St. Augustine physician will discuss your options to choose the best procedure for you.


Most patients have good recovery results, but it depends on the severity of the injury. Physical therapy is crucial for both surgical and non-surgical treatments for the best potential recovery. Frequently, patients require12 months of rehab before they are pain-free and back to a normal lifestyle.

If you have pain in your Achilles tendon, call for an evaluation by an Orthopaedic Associates of St. Augustine physician. Our physicians are fellowship-trained and stay up-to-date on the latest non-surgical and surgical techniques.