Insertional Achilles Tendinopathy: The Central Approach

  • James A. NunleyEmail author
  • John S. ReachJr.

Insertional Achilles tendinopathy is a painful, frequently disabling condition of the posterior foot and ankle. Discomfort and irritation typically arise along the posterior aspect of the heel. As with most tendinopathies, pain begins intermittently and gradually becomes constant as the disease progresses. A common sign of this insertional tendon disease is the patient’s difficulty in wearing closed-back shoes. Athletically inclined patients may report more pain after exercise.

Despite advances in basic science tendon research, the pathophysiology of insertional Achilles tendinopathy is still not well understood. Traditionally, the disease has been viewed as an overuse phenomenon. Shear forces between collagen fascicles as well as biomechanical problems at the osseotendinous junction have been cited as causative factors in the disease. Recently, molecular collagen studies have hinted at the role of tenocytic chondral metaplasia as a causative factor.1Other studies have focused on the...


Achilles Tendon Diffuse Idiopathic Skeletal Hyperostosis Flexor Hallucis Longus Nonoperative Side Calcific Tendinopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Maffulli NReaper J, Ewen SW, et al. 2006; Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon. Clin J Sport Med 16:(4)329–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Knobloch K, Kraemer R, Lichtenberg A,. et al. 2006; Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med 34:(1)92–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Fahlstrom M, Jonsson P, Lorentzon R,. et al. 2003; Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc 11:(5)327–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Furia JP. 2006; High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med 34:(5)733–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Ohberg L, Alfredson H. 2003; Sclerosing therapy in chronic Achilles tendon insertional pain-results of a pilot study. Knee Surg Sports Traumatol Arthrosc 11:(5)339–43.PubMedCrossRefGoogle Scholar
  6. 6.
    Scutt N, Rolf C, Scutt A. 2006; Glucocorticoids inhibit tenocyte proliferation and tendon progenitor cell recruitment. J Orthop Res 24:(2)173–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Kolodziej P, Glisson RR, Nunley JA. 1999; Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund's deformity: a biomechanical study. Foot Ankle Int 20:(7)433–7.PubMedGoogle Scholar
  8. 8.
    Calder JD, Saxby TS. 2003; Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int 24:(2)119–21.PubMedGoogle Scholar
  9. 9.
    Wagner E, Gould J, Bilen E,. et al. 2004; Change in plantarflexion strength after complete detachment and reconstruction of the Achilles tendon. Foot Ankle Int 25:(11)800–4.PubMedGoogle Scholar
  10. 10.
    Schepsis AA, Jones H, Haas AL. 2002; Achilles tendon disorders in athletes. Am J Sports Med 30:(2)287–305.PubMedGoogle Scholar
  11. 11.
    Schepsis AA, Wagner C, Leach RE. 1994; Surgical management of Achilles tendon overuse injuries. A long-term follow-up study. Am J Sports Med 22:(5)611–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Paavola M, Kannus P, Paakkala T,. et al. 2000; Long-term prognosis of patients with Achilles tendinopathy. Am J Sports Med 28:(5)634–42.PubMedGoogle Scholar
  13. 13.
    Watson AD, Anderson RB, Davis WH. 2000; Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional Achilles tendinosis with calcific spur. Foot Ankle Int 21:(8)638–42.PubMedGoogle Scholar
  14. 14.
    Yodlowski ML, Scheller AD Jr, Minos L. 2002; Surgical treatment of Achilles tendinitis by decompression of the retrocalcaneal bursa and the superior calcaneal tuberosity. Am J Sports Med 30:(3)318–21.PubMedGoogle Scholar
  15. 15.
    Clain MR, Baxter DE. 1992; Achilles tendinitis. Foot Ankle 13:(8)482–7.PubMedGoogle Scholar
  16. 16.
    Kleiger, B. 1988; The posterior calcaneal tubercle impingement syndrome. Orthop Rev 17:(5)487–93.PubMedGoogle Scholar
  17. 17.
    McGarvey WC, Palumbo RC, Baxter DE,. et al. 2002; Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach. Foot Ankle Int 23:(1)19–25.PubMedGoogle Scholar
  18. 18.
    Johnson KW, Zalavras C, Thordarson DB. 2006; Surgical management of insertional calcific Achilles tendinosis with a central tendon splitting approach. Foot Ankle Int 27:(4)245–50.PubMedGoogle Scholar
  19. 19.
    Graham DJ COX-2 inhibitors, other NSAIDs, and cardiovascular risk: the seduction of common Sense. JAMA. 2006;296(13): 1653–6. Epub 2006 Sep 1PubMedCrossRefGoogle Scholar
  20. 20.
    Hernández-Diaz S, Varas-Lorenzo C, García Rodríguez LA Non-steroidal antiinflammatory drugs and the risk of acute myocardial infarction. Basic Clin Pharmacol Toxicol. 2006;98(3):266–74.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Surgery, Division of Orthopaedic SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations