Non-Insertional Achilles Tendonitis.


What is Non-Insertional Achilles Tendonitis?

Non-insertional Achilles tendonitis is a common condition that affects the Achilles tendon, a strong band of tissue that connects your calf muscles to your heel bone. Unlike insertional Achilles tendonitis, which primarily affects the point where the tendon attaches to your heel bone, non-insertional Achilles tendonitis affects the middle portion of the tendon. This condition can cause pain, swelling, and discomfort in the back of your leg, just above your heel.


What causes non-insertional Achilles tendonitis?

Non-insertional Achilles tendonitis is typically a result of overuse and degeneration of the Achilles tendon. Several factors can contribute to this condition, including:

  • Repetitive stress on the Achilles tendon, often from activities like running, jumping, or dancing.
  • Tight calf muscles.
  • Inadequate calf muscle strength.
  • Sudden increase in physical activity.

What are the treatment options for non-insertional Achilles tendonitis?

Treatment for non-insertional Achilles tendonitis depends on the severity of the condition. Common treatment options include:

  • Rest: Reducing or avoiding activities that exacerbate the pain is essential for recovery.
  • Ice: Applying ice to the affected area can help reduce pain and swelling. Apply ice for 15-20 minutes at a time, several times a day.
  • Orthotics: Custom-made or over-the-counter shoe inserts can provide better shock absorption in the heel and sometimes more arch support, to help reduce strain on the Achilles tendon.
  • Medications: Over-the-counter pain relievers and anti-inflammatories can help manage pain and inflammation.
  • Physiotherapy: A physiotherapist can recommend exercises to stretch and strengthen the calf muscles, improve flexibility in the Achilles tendon, and correct biomechanical issues. Commonly these include calf muscle specifically Gastrocnemius stretching and heel drop exercises (see below) to stretch the Achilles and calf muscles.
  • Eccentric Exercises / Heel drops: Eccentric exercises involve controlled lengthening of the Achilles tendon and can be particularly helpful in rehabilitation. These are the best and most evidence-based treatment for overall recovery from non-insertional Achilles tendonitis.

      Heel drop exercises help stretch the Achilles tendon and calf muscles. Here's how to perform them:

    • a. Stand on a step (bottom of stairs or door step for example), with only the balls of your feet on the step so that your heels are hanging off the edge.
    • b. Slowly lower your heels down toward the ground until as far as you can, so you feel a stretch in the calves and Achilles tendons. It will feel uncomfortable in the Achilles tendon if you are doing it correctly. This is normal.
    • c. Hold the stretch with your heels as far down as you can and count to 10, then raise your heels back up to the starting position.
    • d. Repeat the exercise 10-15 times, twice a day.
    • e. Gradually increase the number of repetitions you do as you improve and can tolerate more. You can also try to do them with only a single heel by lifting one foot off the step and dropping the whole of your weight using just one foot. Be sure to balance yourself with a banister or rail if attempting this and only do this if you feel confident to progress from doing them with two feet with ease.
  • Heel Lifts: These can help reduce tension on the Achilles tendon but should be used only for a very short time as a temporary measure only if pain is severe. Prolonged use can result in more tightness in the Achilles tendon which may worsen and/or prolong the duration of symptoms.
  • Extracorporeal Shock Wave Therapy (ESWT): A non-invasive treatment that uses shock waves to stimulate healing in the affected area. This may be recommended as a second line treatment after stretching and physiotherapy.

How can I try to prevent Achilles tendonitis?

To reduce the risk of non-insertional Achilles tendonitis, consider the following preventive measures:

  • Gradually increase the intensity of your physical activity.
  • Stretch your calf muscles regularly.
  • Ensure you have appropriate footwear with proper arch support and cushioning, especially when doing exercise such as running or impact sports.

When should I seek medical help?

If your symptoms are severe, do not improve with home treatment, or if you suspect a more serious injury, seek medical attention. Do not home diagnose your condition. Consult with a healthcare professional early for a proper diagnosis and personalised treatment plan for non-insertional Achilles tendonitis. Early intervention can lead to a faster and more complete recovery.