Insertional Achilles Tendinopathy at Foot Foundation
Insertional Achilles tendinopathy causes pain right where the tendon attaches to the heel bone. Unlike mid-portion tendinopathy, this condition is linked to compressive stress and degenerative changes at the tendon–bone interface, often making everyday activities like climbing stairs, running uphill, or even wearing shoes with rigid backs uncomfortable.
Specialist care is essential for managing insertional pain.
At Foot Foundation, treatment focuses on restoring tendon health, reducing strain at the insertion, and providing tailored rehabilitation so you can move with ease again.
What is Insertional Achilles Tendinopathy?
Insertional Achilles tendinopathy affects the lower portion of the Achilles tendon where it attaches to the heel bone (posterior calcaneus). Unlike mid-portion tendinopathy, it involves compressive and tensile stress at the tendon–bone interface, often combined with degenerative changes, microtearing, and in some cases calcification or spur formation.
It is commonly aggravated by activities that involve ankle dorsiflexion such as running uphill, climbing stairs, or squatting. Footwear with rigid heel counters may also trigger symptoms.
Causes & Risk Factors
Repetitive running, jumping, or sports involving high Achilles load
Rapid increases in training load or sudden changes in activity
Poor biomechanics – excessive pronation, high arches, or restricted ankle dorsiflexion
Tight calf muscles or weak calf strength-endurance
Poor footwear or worn-out trainers
Occupational load (long hours standing, walking, or climbing)
Age-related degeneration (most common between 30–50 years)
Medical and systemic risk factors: diabetes, obesity, inflammatory arthritis
Medication history: fluoroquinolone antibiotics or previous corticosteroid injections
Treatment at Foot Foundation
Exercise therapy – eccentric loading and heavy-slow resistance programs proven to restore tendon function
Shockwave therapy (ESWT) – stimulates tendon healing in chronic cases
Custom orthotics – correct abnormal biomechanics and reduce tendon strain
Heel lifts – temporary offloading during painful stages
Manual therapy and calf release – improve flexibility and reduce compensatory loading
Footwear modification – cushioned, supportive shoes with slight heel elevation
Return-to-sport planning – structured, graded rehabilitation to prevent recurrence
Symptoms
Pain and stiffness in the tendon 2–6 cm above the heel
Morning stiffness that improves with activity but worsens again afterwards
Pain with running, sprinting, jumping, or uphill walking
Tenderness when squeezing the tendon
Swelling or thickening in chronic cases
Diagnosis
At Foot Foundation, diagnosis is made through:
Detailed clinical history and examination
Palpation to localise tendon tenderness
Functional strength/endurance testing (single-leg heel raises, hopping)
Gait and biomechanical assessment
Imaging (ultrasound or MRI) in resistant or complex cases to confirm degenerative changes and rule out partial tears
Insertional Achilles Tendinopathy – FAQs
What is the difference between insertional and mid-portion Achilles tendinopathy?
Mid-portion tendinopathy occurs 2–6 cm above the heel, while insertional tendinopathy affects the point where the tendon attaches to the heel bone. The mechanisms differ: mid-portion is typically due to tensile overload, whereas insertional involves both tensile and compressive stress at the bony interface.
What causes insertional Achilles pain?
It develops from repetitive overload and compressive forces, especially in activities involving ankle dorsiflexion. Poor footwear, calf tightness, and bony changes such as Haglund’s deformity increase the risk.
How long does it take to recover from insertional Achilles tendinopathy?
Recovery depends on the severity and chronicity. With specialist care, improvement is often seen in 8–12 weeks, but chronic cases with calcification may take several months to fully rehabilitate.
What is the best treatment for insertional Achilles pain?
The most effective treatment combines:
Loading exercises tailored to the insertion (avoiding deep dorsiflexion initially)
Shockwave therapy in chronic cases
Orthotics and footwear modification
Heel lifts for temporary pain relief
Can orthotics help insertional Achilles tendinopathy?
Yes. Orthotics correct abnormal biomechanics, reduce excessive pronation or supination, and offload the tendon. They are especially effective when combined with strengthening and footwear changes.
Is shockwave therapy effective?
Yes. Shockwave therapy is widely used for chronic insertional tendinopathy, improving pain and stimulating tendon healing where exercise alone has been insufficient.
Do I need surgery for insertional Achilles tendinopathy?
Surgery is rarely required. It may be considered only in severe cases involving large bone spurs, significant calcification, or chronic degeneration unresponsive to conservative care.
What footwear is best for insertional Achilles pain?
Shoes with soft heel counters, cushioning, and slight heel elevation are recommended. Rigid heel tabs or minimal-cushion shoes should be avoided as they can irritate the tendon insertion.
Can insertional Achilles tendinopathy recur?
Yes. If underlying biomechanics or calf tightness are not addressed, recurrence is common. Long-term prevention includes orthotics, calf flexibility work, and appropriate footwear.
When should I see a podiatrist?
If heel pain persists longer than two weeks, interferes with walking, or worsens with activity, it is important to seek specialist care. Early treatment prevents the condition from becoming chronic.
Why Choose Foot Foundation?
Foot Foundation provides specialist-level care for insertional Achilles tendinopathy, combining podiatry and physiotherapy expertise. We use advanced assessment, orthotic intervention, shockwave therapy, and tailored exercise programs to achieve long-term recovery.
With clinics in Rosedale, Takapuna, Remuera, Botany, Hamilton, and Tauranga, patients have access to expert care across New Zealand.
