There are several possible problems that would result in “heel pain.” In the last article, I discussed plantar fasciitis and home care treatments. There is another variety of heel pain called Achilles tendonitis, which is further separated as insertional vs noninsertional tendonitis. Although the differences are subtle, treatment plans are different. So how do you know which one you have?

Symptoms of Achilles tendonitis:
– Pain or a pulling sensation to the back of your heel where the Achilles tendon is (it connects your calf muscle to the heel bone)
– Compared to plantar fasciitis which is pain to the bottom of your heel where the plantar fascia is

What is insertional Achilles tendonitis?
– This is inflammation of the Achilles tendon where it inserts into the calcaneus bone (heel). Sometimes the inflammation can be directly related to a bone spur.
– Treatments include curbing activities that make it more painful, resting, gentle stretching exercises, weight loss, heel lifts and padding the heel to prevent rubbing against a shoe.
– In surgical cases, the bone spur may need to be shaved down. The Achilles tendon may need to be detached to shave the bone spur and then re-attached again with anchors. Recovery time varies from 4-12 weeks depending on whether or not the tendon was repaired.

What is non-insertional Achilles tendonitis?
– This is inflammation of the Achilles tendon approximately 4cm above the heel bone. This is a common area of injury because it has less vascularity (blood flow) than other areas making it susceptible to injuries. Overtime, this area may become thicker from degeneration.
– This is common in active individuals and is referred to overuse injury. Rest, using a walking boot and/or cast may be necessary.
Shockwave therapy would be useful in chronic soft tissue conditions such as this
– In surgical cases, the tendon may need to be cleaned out (debrided) to remove chronically inflamed tissue, and repaired if a torn is present.
– If this injury is left ignored, it may lead to partial tear or complete rupture.

If you have heel pain that does not go away after 1 month of home care, come get evaluated by a foot & ankle specialist to make sure nothing else is going on. The sooner you address the problem, the sooner you’ll get back to your normal activities. 

Call us to schedule your next appointment at 831-288-3400. 


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