Achilles tendon complaints on heel bone (insertion complaints)

As you can read in the general blog about achilles tendon complaints, there are different types of Achilles tendon complaints. This article is only about the insertion Achilles tendon tendinopathy. It is important to differentiate with other types of achilles tendon complaints because the treatment is different!

Insertion Achilles tendon complaints are located at the spot where the Achilles tendon inserts on to the heel bone (calcaneus). This can be seen in Figure 1.

What is the difference with other types of Achilles tendon complaints?

In the case of the insertion complaints, the compression of the tendon plays a major role. Compression of the tendon against the heel bone occurs mainly in the final phase of dorsiflexion (pulling the toes towards you).

The type of exercises that are associated with this type of Achilles tendon complaints is different from the exercises with a mid-achilles tendon complaint.

The complaints arise just as with the other types of Achilles tendon complaints due to overload of the tendon, read more about this in the general blog about the Achilles tendon..

Type of insertion Achilles tendon tendinopathy

Reactive tendinopathy: This is usually with an increase in training load. For example by walking more kilometers per week or more hills in the training. The tendon can be swollen and painful.

Degenerative tendinopathy: The degenerative tendinopathy is when there are complaints for a long time. At this stage the structure of the tendon has already changed a lot. With these complaints, the Achilles tendon can be swollen or bumps may form on the tendon. If you continue to exercise with this, there is a chance that the tendon will partially or completely tear. However, you must then continue to sport for a very long time. 

Phases of recovery

The recovery of the insertion Achilles tendon complaints goes through a number of phases, it differs per person how long the phases last. This depends on many factors such as the degree of tendon damage, duration of complaints, tendon health, age etc.

Phase 1. Pain reduction

In the first instance, reducing pain is important, for which 2 steps are important.

Step 1. Managing the load

The insertion complaints are aggravated by compression, by high tensile forces of the calf muscles and by the shorter and lengthening of the tendon (such as during running, jumping, etc.). To tackle these three factors, a number of measures must be taken. To reduce compression, it is important not to get into dorsiflexion. For example, avoid running uphill or the heel drop exercises.

Do not use shoes where the heel is very tight and therefore exerts pressure on the attachment of your Achilles tendon. Shoes with a higher heel may help to reduce the pressure, you can also use a heel enhancement.

And perhaps most importantly, do not stretch the calf muscles! Stretching the calf muscles causes compression and can make the symptoms worse!

Step 2. Isometric exercises

To reduce the pain and control the tensile forces, it is important to perform the following two exercises.

Exercise 1: Isometric M. Soleus holds
Execution: Stand on the toes, bend the knees to about 90 degrees and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Exercise 2: Isometric M. Gasctrocnemius holds
Execution: Stand on the toes, keep the knees extended and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Phase 2. Improve strength

When the pain is gone and the symptoms are gone, you can start training the strength of the calf muscles. Calfraises are the right exercises for this. You must do this exercise with both straight and bent knees. Below the explanation of the exercise:

Exercise 1: Heelraise stretched knee
Execution: Stand on one leg. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Heelraise bent knee
Execution: Stand on one leg with bent knee. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

During this exercise the complaints should not increase, if this is the case the exercise is still too heavy for that moment. What is important in exercise 2 heeled knee is that you do not get an increase in the symptoms. If this is the case, you should bend the knee less. For example, start with 10 to 15 degrees of knee flexion and build it to 25 degrees.

Phase 3: Running!

Now you start running again! It is important that you start up quietly, ask for help from your therapist. Make sure that everything you do is virtually pain-free. It may be that you get some sensitivity during the build-up, as long as it is a maximum of 4 on a scale of 0 to 10 you do not have to worry about it. If the complaints then go away again. See figure 2 as an example.

Besides starting to walk, it is important to do the following exercises.

Exercise 1: Triple extention

Execution: Stand on one leg with bent knee, bend your torso slightly forward. Now stand checked on the toes while simultaneously stretching your knee and hip. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Calfraise stretched knee with resistance

Execution: Stand on one leg. Put a large resistance band around your feet and your shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 3: Heelraise bent knee with resistance
Execution: Stand on one leg with bent knee. Put a large resistance band around the feet and shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.