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Insertional Achilles Tendinopathy Treatment at Foot Foundation

Insertional Achilles tendinopathy affects the lower tendon where it attaches to the heel bone. Patients often experience pain with stairs, hills, or stiff-heeled shoes.

At Foot Foundation, our podiatrists provide evidence-based care with exercise therapy, shockwave, footwear changes, and orthotics to reduce pain, restore mobility, and prevent long-term damage.

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 overload at the tendon insertion

  • Compressive stress from ankle dorsiflexion (uphill running, stair climbing)

  • Biomechanical factors – flat feet, high arches, restricted ankle mobility

  • Poor footwear – stiff heel counters, lack of cushioning

  • Calf tightness – increased strain on the tendon insertion

  • Age-related degeneration – reduced tendon elasticity and vascularity

  • Haglund’s deformity – bony enlargement at the back of the heel contributing to irritation

  • Sports and activity load – common in runners, jumpers, and athletes with repetitive stress

Treatment at Foot Foundation

  • Modified loading programs – progressive tendon strengthening while avoiding excessive dorsiflexion

  • Shockwave therapy (ESWT) – effective in chronic insertional tendinopathy

  • Custom orthotics – to correct abnormal biomechanics and reduce insertional strain

  • Heel lifts – temporary use to offload compressive forces

  • Footwear advice – cushioned, supportive shoes avoiding rigid heel counters

  • Manual therapy & calf release – to reduce contributing calf tightness

  • Surgical referral – in severe cases with significant calcification, bone spur, or tendon degeneration not responding to conservative care

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

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.

 

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