Resources for Insertional Achilles Tendonitis

Where does it ache?

Achilles tendonitis is when the thick and tough tendon that attaches your calf to your heel starts to bother you. 

It can ache at different times such as before, during, and/or after a run. It can often go away once you warm up and it may be sore to the touch. If the discomfort is a couple inches above the heel, it’s just “Achilles Tendonitis” but if it’s at the very bottom around/at the heel bone it is referred to as “Insertional Achilles Tendonitis” because that is where the achilles attaches to the heel bone. 

Why does it ache?

Causes can range from overloading the tissue due to calf weakness, training stress overload, maybe biomechanics such as excessive pronation. As with most injuries the cause is not always known for the individual or for the injury in general. 

More recently, researchers suggest that only part of the achilles tendon takes the majority of the stress while running. This causes the forward part to weaken since it’s never under as much stress, and this weakening causes the injury. 

So, what should you do?

With achilles problems, one of the answers is very often doing eccentric calf drops. 

These are sort of the opposite of calf raises, where you perhaps hold some weight and slowly raise up onto your tippy toes (dorsiflexing). The eccentric calf drops instead are where you slowly lower yourself down. 

Dr Thomas C. Michaud, writing at Competitor.com, says “Another factor to consider when managing insertional Achilles injuries is that the heel counter of the running shoe should not contact the damaged portion of the Achilles insertion. Over the past few years, many running shoe manufacturers have added a forward angulation to the upper portion of the heel counter that causes it to project directly into the Achilles tendon. This addition often pushes into the back the Achilles insertion and causes chronic inflammation, particularly if a Haglund’s deformity is present. Treatment in this situation is to look for sneakers that do not contact the Achilles insertion. A simple alternative is to cut off the upper back section of the heel counter so it no longer touches the tendon. It is also important to avoid heavy motion control sneakers when treating Achilles tendon injuries because their inherent stiffness increases the length of the lever arm from the ankle to the forefoot, thereby increasing strain on the Achilles tendon.”

How do I perform calf drops?

John Davis at Runners Connect says “The strength protocol consists of two exercises: a straight-kneed and a bent-kneed eccentric heel drop. The protocol calls for three sets of fifteen heel drops, both bent-kneed and straight-kneed, twice a day for twelve weeks.

Standing on a step with your ankles plantarflexed (at the top of a “calf raise”), shift all of your weight onto the injured leg. Slowly use your calf muscles to lower your body down, dropping your heel beneath your forefoot. Use your uninjured leg to return to the “up” position. Do not use the injured side to get back to the “up” position! The exercise is designed to cause some pain, and you are encouraged to continue doing it even with moderate discomfort. You should stop if the pain is excruciating, however.

Once you are able to do the heel drops without any pain, progressively add weight using a backpack. If you are unlucky enough to have Achilles tendon problems on both sides, use a step to help you get back to the “up” position, using your quads instead of your calves to return up.

What’s the bottom line? The eccentric exercises are thought to selectively damage the Achilles tendon, stripping away the misaligned tendon fibers and allowing the body to lay down new fibers that are closer in alignment to the healthy collagen in the tendon. This is why moderate pain during the exercises is a good thing, and why adding weight over time is necessary to progressively strengthen the tendon”

What else?

It may seem counter-intuitive from what you’ve been told, but avoiding anti-inflammatory drugs like Ibuprofen may help since these shut off the healing factors of inflammation. 

Performing a proper warmup before a run and icing the area after a run can be helpful. But most important is to strengthen the lower rear leg with the calf drops! 

The below video on Haglunds Deformity touches base on an important shoe buying consideration, and that’s the stiffness of the rear heel-counter. If you have this deformity, a bump at the rear of your foot, and/or your shoe’s heel pocket is stiff or presses into your achilles, there could be major problems. I find it best to avoid purchasing shoes with a heel counter that is stiff or presses into your foot.