Insertional Achilles Tendonitis Treatment in NYC

Manhattan Physical Therapy
Insertional Achilles Tendonitis Treatment in NYC

Insertional Achilles tendonitis is a common condition affecting the back of the heel where the Achilles tendon attaches to the bone. This tendon, which connects the calf muscles to the heel (calcaneus), can gradually degenerate over time due to repetitive stress or overuse.

Unlike mid-portion Achilles tendonitis, insertional tendonitis specifically affects the tendon’s attachment point, often causing pain, swelling, and stiffness that interfere with daily activities.

What Is Insertional Achilles Tendonitis?

Insertional Achilles tendonitis occurs when the lower portion of the Achilles tendon experiences degeneration, small tears, or inflammation. It is sometimes described using terms such as tendinosis or paratendonitis. Patients often notice pain at the back of the heel, especially after activities like running, jumping, or walking uphill. Over time, the tendon may swell or thicken, creating discomfort when wearing shoes or stretching the tendon.

The condition develops gradually, often without a specific injury. Some patients notice sudden flare-ups of pain, while others experience mild discomfort that slowly worsens. It is more common in older adults, athletes, and individuals with contributing factors like being overweight, diabetes, or recent changes in activity levels or footwear.

What Causes Insertional Achilles Tendonitis?

The most common cause of insertional Achilles tendonitis is repetitive stress on the tendon at its attachment to the heel bone. Activities like running, jumping, and sports that require sudden acceleration or deceleration can increase the risk. Additional factors that can contribute include:

  • Age-related tendon degeneration

  • Poorly fitted or worn-out shoes

  • Sudden increases in training intensity

  • Underlying medical conditions such as diabetes

  • Long-term use of corticosteroids

Over time, the tendon may develop calcium deposits or bony growths called heel spurs. While these spurs often appear on X-rays, they do not always cause pain. Many patients improve with conservative treatment without needing surgical intervention.

What Are the Symptoms?

Insertional Achilles tendonitis presents with several key symptoms that can affect daily life:

  1. Pain at the back of the heel – Often described as sharp, burning, or aching, worsening during activity.

  2. Swelling and thickening – Swelling is usually localized near the tendon’s attachment and can make shoe-wearing uncomfortable.

  3. Tenderness to touch – Direct pressure on the back of the heel is often painful.

  4. Stiffness – Especially noticeable in the morning or after prolonged inactivity.

  5. Reduced ankle movement – Pain and swelling may limit dorsiflexion (lifting the foot upward).

  6. Creaking or crunching sensations – Known as crepitus, this may be felt when moving the ankle.

How Is It Diagnosed?

Accurate diagnosis combines a clinical assessment with imaging studies when necessary.

  • Medical History: The doctor will review your symptoms, activity levels, and any prior injuries to understand the condition’s progression.

  • Physical Examination: The tendon is assessed for swelling, tenderness, range of motion, and stiffness.

  • Imaging:

    • X-rays can reveal heel spurs or calcium deposits.

    • Ultrasound provides real-time images to detect tendon thickening, tears, or inflammation.

    • MRI offers detailed imaging for severe or unclear cases to evaluate tendon damage and surrounding structures.

A proper evaluation ensures a treatment plan tailored to the severity of the tendon injury and the patient’s lifestyle goals.

How Is Insertional Achilles Tendonitis Treated?

Treatment for insertional Achilles tendonitis usually begins with conservative approaches aimed at reducing pain, improving tendon strength, and restoring normal ankle and foot function. Surgery is considered only if non-surgical methods fail after several months of consistent therapy.

Non-Surgical Treatment

Most patients find significant relief with non-surgical care, which typically includes the following strategies:

1. Rest and Activity Modification
Reducing activities that put repeated stress on the Achilles tendon is essential. Running, jumping, or walking uphill can worsen the injury, so these should be minimized during recovery. Low-impact exercises, such as swimming, cycling, or using an elliptical machine, allow you to maintain fitness while protecting the tendon. Gradual reintroduction of higher-impact activities is guided by pain levels and physical therapist recommendations.

2. Footwear Adjustments
Supportive footwear can play a critical role in alleviating tendon stress. Shoes with a soft, cushioned heel or built-in heel lifts reduce pressure on the tendon insertion. Avoiding worn-out or stiff shoes is important, as these can aggravate pain and prolong recovery.

3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Short-term use of NSAIDs can help reduce pain and inflammation, making it easier to perform exercises and daily activities. However, these medications do not treat the underlying tendon degeneration and should be combined with physical therapy for best results.

4. Physical Therapy
Physical therapy is often the most effective component of non-surgical treatment. A structured program focuses on:

  • Strengthening the Achilles tendon through controlled exercises

  • Improving ankle mobility and flexibility

  • Correcting gait or movement patterns that contribute to tendon stress

Eccentric exercises—where the heel is slowly raised and lowered—are particularly beneficial for promoting tendon healing and improving resilience. A physical therapist can tailor these exercises to your condition, monitor progress, and adjust intensity safely.

5. Additional Therapies
For patients who do not respond fully to standard conservative care, other options may be considered:

  • Extracorporeal Shockwave Therapy (ESWT)

  • Temporary Braces, Night Splints, or Walking Boots

Important Note: Cortisone or steroid injections are generally avoided because they can increase the risk of tendon rupture. Some patients explore platelet-rich plasma (PRP) injections, though evidence on their effectiveness remains limited.

 

Surgical Treatment

Surgery is considered when conservative treatments fail after 3–6 months. Surgical approaches depend on the severity of tendon damage:

  • Debridement and tendon repair

  • Bone spur removal

  • Tendon transfer

Recovery after surgery requires careful rehabilitation: patients are usually in a splint or removable boot for 6–8 weeks, with full recovery often taking 9 months or longer. Physical therapy is crucial to restore strength, flexibility, and safe return to activities.

Exercises for Strength and Pain Relief

Targeted exercises help strengthen the Achilles tendon and improve function. A physical therapist can tailor these to your needs, but commonly recommended exercises include:

1. Seated Heel Raises

  • Sit in a chair with feet flat on the floor, a small weight on your knees.

  • Lift heels slowly (3 seconds), hold 2 seconds, and lower (3 seconds).

  • Repeat for 10–15 repetitions, 2–3 sets.

2. Static Hold on Step

  • Stand with heels off the edge of a step.

  • Hold position for 30 seconds, rest 1 minute, repeat 3–5 times.

  • Progress to single-leg holds as tolerated.

3. Standing Heel Raises (Knee Straight or Bent)

  • Raise both heels with knees straight or slightly bent, hold at top, lower slowly.

  • Perform 10–15 repetitions, 2–3 sets.

  • Single-leg versions can be added for more advanced strengthening.

4. Single Knee Dips

  • Stand on one leg, bend the knee slowly, keeping the heel on the ground.

  • Lower as far as comfortable, return to start.

  • Repeat 8–12 repetitions, 2–3 sets.

5. Mini Hops on One Leg

  • Stand on one leg and perform small hops in place.

  • Start with 10 repetitions, rest 1 minute, repeat 2–3 sets.

If you’re experiencing persistent heel pain or suspect insertional Achilles tendonitis, don’t wait—schedule a consultation at Manhattan Physical Therapy today or Call (212)-213-3480 to book your appointment.

What Do They Say About Us?

Alexander Liu

"Everyone on the team at Manhattan Physical Therapy is super nice and caring. They were able to pretty quickly diagnose my knee and hip problems and immediately put me to work to reduce the pain.."

Henry Myerberg

"You're not just a patient when you come to the Manhattan Physical Therapy. You feel like family there. In particular, Erica with her colleagues John, Lidia and Joe not only fix and improve you physically, they make you feel welcomed and cared for.."

Hakyung Kim

"Everyone is so kind and helpful! my knee and hip pain have improved massively since starting Manhattan PT, highly recommend to anyone. special thanks to Bianca, Lidia, Joe, and John!"


Manhattan Physical Therapy

✆ Phone (appointments):
(212) 213-3480

Address: 385 5th Ave, Suite 503, New York, NY 10016