​Insertional Achilles tendinopathy is a condition affecting the point where the Achilles tendon attaches to the heel bone. It can cause pain, stiffness and swelling at the back of the heel, particularly with activity or pressure from footwear.

Mr Edward Dawe is a Consultant Foot & Ankle Surgeon specialising in the assessment and treatment of insertional Achilles tendinopathy, offering both non-surgical and surgical treatment options. Clinics are available in Chichester, Worthing and Haywards Heath.

What is insertional Achilles tendinopathy?

Insertional Achilles tendinopathy occurs when the tendon becomes damaged and degenerative at its attachment to the heel bone. This may be associated with inflammation, thickening of the tendon and sometimes bone spurs.

​Symptoms of insertional Achilles tendinopathy

​Common symptoms include:

• Pain at the back of the heel  
• Stiffness, particularly after rest  
• Swelling or thickening at the tendon insertion  
• Pain when wearing certain shoes  
• Discomfort during walking or activity  

Non-surgical treatment

Many patients improve with non-surgical treatment. Options may include:

• Activity modification  
• Physiotherapy  
• Footwear adjustments  
• Heel lifts  
• Pain relief medication  

These treatments aim to reduce symptoms and improve function but do not reverse tendon degeneration.

Surgical treatment

Surgery may be considered if symptoms persist despite non-surgical management.

Procedures may involve removing damaged tendon tissue, addressing any bone spurs and repairing the tendon. The most appropriate treatment depends on the severity of the condition and individual patient factors.

When to seek specialist advice

If you have ongoing pain at the back of your heel that does not improve with rest or simple measures, specialist assessment can help determine the cause and guide treatment.

Frequently asked questions

What causes insertional Achilles tendinopathy?
It is often caused by repeated stress on the tendon at its attachment to the heel bone, leading to degeneration over time.
Is insertional Achilles tendinopathy the same as Achilles tendinitis?
Insertional tendinopathy refers to degenerative changes at the tendon insertion, whereas tendinitis implies inflammation. In practice, both terms are often used interchangeably.
Can insertional Achilles tendinopathy improve without surgery?
Yes, many patients improve with physiotherapy, footwear changes and activity modification.
When is surgery needed?
Surgery may be considered if symptoms persist despite non-surgical treatment and significantly affect daily activities.