Insertional Achilles tendinopathy

Your Achilles tendon is the strongest tendon in the body found just behind and above your heel. It joins your heel bone (calcaneum) to your calf muscles. The Achilles tendon is very important in absorbing shock (especially when running) and enabling you to push up onto your toes e.g. climbing hills/stairs.

What is Achilles tendinopathy?

Achilles tendinopathy is essentially wear and tear of the Achilles tendon. It can cause pain, swelling and stiffness of the Achilles tendon. Achilles tendinopathy can be divided according to what part of the tendon is affected. The two types are insertional tendinopathy and midpoint tendinopathy.

Download leaflet (PDF)

Causes and symptoms

Causes of insertional Achilles tendinopathy

Risk factors for developing Achilles tendinopathy include:

Overweight
Poor fitting footwear
Diabetes
High cholesterol
Overuse of the Achilles tendon, for example runners, playing tennis and activities involving a lot of jumping
Sudden changes to your training programme or activities – such as frequency, duration or training surface – without a sufficient adaptation period
Weakness of your calf muscle

Symptoms of insertional Achilles tendinopathy

The main symptoms include pain and stiffness where the tendon inserts onto your calcaneum (heel bone). This area may feel swollen. The pain and stiffness often develops gradually over time. Stiffness is usually worse when you first wake up in the morning. Pain is generally worse during and after exercise and may affect your daily activities.

Self management of insertional Achilles tendinopathy

Weight loss

If you are overweight you are putting extra load through your knee. This will be contributing to your condition. Therefore, losing weight will improve your symptoms.

The NHS website has some useful resources:

BMI calculator Weight loss plan Exercise advice

Stopping smoking

Smoking is a well recognised risk factor in the development of achilles tendinopathy, it is therefore important to try and stop.

The NHS website has some useful resources:

Quit smoking

Footwear

Tight fitting footwear, especially around the heel, is a common cause of insertional achilles tendinopathy. If you feel this is the case you may want to try different footwear.

Activity management

Reduce your levels of activity to a point where you feel no pain. Maintain this level of activity and the tendon may settle in as little as 5-10 days. However, it may take several weeks to fully settle. For mild cases you may be able to continue some normal activities as long as you’re able to keep it relatively pain free.

Diabetes/raised cholesterol

If you suffer with these conditions it is important to ensure they are well controlled. Speak to your healthcare professional for advice on improving your control.

Exercises for insertional Achilles tendinopathy

Exercise 1: standing heel raises

Stand with your feet slightly apart and parallel
Place your hands on the wall or a chair for balance
Raise your heels as high as you can
Return

Exercise 2: single leg heel raises

Put your hand on a wall or other stable surface for balance
While standing on one leg, raise up on your toes as you lift your heel off the ground
Keep your knee straight

Exercise 3: single leg heel raise with knee bent

In standing – stand in a supported position
With your knee slightly bent, raise up onto your toes (heel raise)
Lower heel down slowly
Repeat

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Given insertional Achilles tendinopathy is commonly caused by ill fitting footwear, your GP refer you to see a podiatrist.

The podiatrist will also try to identify any biomechanical problems with the foot that can be addressed with insoles or orthotics.

Page updated 01/12/2020. Review date 01/01/2024

More exercises