Achilles Insertional Tendinopathy

Your Achilles tendon arises from the gastrocnemius and soleus muscles. It becomes a tendon in the mid-calf and inserts on to the heel bone (calcaneus).

What is Achilles Tendinopathy?

This is a problem in the middle of the Achilles tendon.

With increased loading of the tendon, the tissues within develop small cracks and splits.

Plantaris a variable small tendon lying on the inside of the achilles may also have a role in ongoing inflammation and pain in this area.

The layer around the tendon called the paratenon can get inflamed. This can lead to increased blood vessel formation from the paratenon to the achilles tendon which is thought to contribute to the pain.

What are the symptoms?

Achilles Non Insertional TendinopathySymptoms may begin without injury.

Initially patients may have pain with the first few steps in the morning that improves as they warm up. This is because the foot has been in a relaxed position overnight and the first few steps stretch the tendon and cause pain.

A similar situation occurs when starting up from a seated position.

Symptoms commonly progress until pain is felt more constantly with activity.

When the condition has been present for a prolonged period you may notice pain, nodules or a swollen tendon when squeezing the mid portion of the tendon.

What is the treatment?

80-90% of patients with Achilles tendinopathy can be treated without an operation.

There are 3 stages of treatment:

Symptom management – to settle reactive tendons before strengthening and loading can occur.

Achilles Non Insertional Tendinopathy 1

  • Avoid aggravating activity
  • Ice massage
  • Anti- inflammatories
  • Isometric calf raises
  • Heel raise
  • Shoe modification
  • Saline injection to strip the blood vessels between the paratenon and the achilles


The goal is to load the Achilles tendon so pain reduces and the quality of the tendon structure improves.

  • Calf raises under physiotherapy guidance

Full loading

Aim to return to full loading without pain.

  • Increase activity – 10% per week
  • Functional exercises as per your physiotherapist

What if these treatments don’t work?

If symptoms persist after 6-9 months of treatment, surgery may be required.

This is an overview of achilles non insertional tendinopathy and is not all inclusive.

If you have any questions please contact Mr Curry’s rooms on (03) 99286560