What Should I Know About Insertional Achilles Tendonitis?

There may be many reasons why you are experiencing a painful Achilles tendon. If you have found yourself negative on the Achilles tendon rupture test, you may be suffering from insertional Achilles tendonitis.

According to statistics, insertional Achilles Tendonitis occurs in 8.5-18% of runners or athletes. (1)

In this article, we will go into details about this condition, its symptoms, and possible treatments. 


What Is Insertional Achilles Tendonitis?

Achilles Tendonitis is basically caused by the inflammation or irritation of the Achilles tendon. This tendon is the largest in the body and connects your calf muscles to your heel bone. It is the tendon that allows you to jump, stand on tiptoes and run.

  • Tendinitis of this tendon is often a result of overuse or degeneration. (2)

Insertional Achilles Tendonitis refers to the location of the inflammation which is at the lower part of the tendon where it connects to the heel. Noninsertional Achilles Tendonitis is located in the middle part of the tendon.

What Is Insertional Achilles Tendonitis?

What Causes Insertional Achilles Tendonitis

As mentioned, the condition is considered to be an overuse injury that mainly affects long-distance runners or sprinters. Still, it is possible for a person who is not active to develop the problem especially if they are aged (3)

There are additional risk factors that may increase the possibility of one developing the condition. These include: (4)

  • Psoriasis
  • ​Reiter’s syndrome
  • ​Gout
  • ​Tight achilles tendon
  • ​Obesity
  • ​Overpronation
  • ​Recent injury

In runners, however, it is most likely that the condition is caused by overuse. For example, changing training intensity, duration and distance can put too much pressure on the tendon while reducing the time it has for repair.

Such overuse increases the rate of tissue degeneration causing the inflammation of the tendon.

What Symptoms Should I Look For?

Although symptoms may vary and may be quite similar to the symptoms experienced by a ruptured Achilles tendon, the following are the most common. (5)

  • Sharp pain at the back of the ankle where the Achilles joins the heel especially on touch
  • Redness or swelling in the insertion area
  • Bone spur- extra bone growth located at the insertion point
  • Pain becomes worse during running
  • Thickening of the tendon
  • Limited range of motion in your ankle
  • Tight calf muscles

If you experience a "pop" and then a sudden pain, it is likely you have a ruptured Achilles tendon, not Tendonitis.

To properly diagnose the condition, a doctor may examine the pain and swelling in your heel or calf. Imaging tests including x-rays, MRI scans or Ultrasounds may be prescribed to confirm the condition.

How Can I Speed Up Recovery?

How Can I Speed Up Recovery

Recovery from Insertional Achilles Tendonitis may take 10-12 weeks before you will be able to return to running but this is if you follow a strict recovery routine.

There are two main phases of recovery-pain reduction and strength building. (6)

Tip 1: Pain Reduction

Like any other inflammation, pain reduction can be achieved by the RICE method. (Rest, Ice, Compression and Elevation).When treating insertional Achilles Tendonitis, focus on reducing the stress on the affected region. This can be done by:

Physical therapy is another good way to help reduce the symptoms.

Anti-inflammatory drugs can also be useful to reduce swelling but always get a prescription from your physician before deciding to take anything.

Tip 2: Strength Building

After the pain has been reduced, the next step is to strengthen the tendon by strengthening the calf muscles. During this stage, you will need to consult your physiotherapist to determine how much load your muscles can bear. (7)

Calf raises are the most common and preferred exercise to help strengthen the calf muscles. To perform a calf raise:

  • Stand straight with one hand on the wall for support
  • ​Lift up your working leg so that all your weight is on the affected leg
  • ​Slowly raise your foot off the ground
  • ​Lower it to the start position with control
  • ​Repeat 10-15 times and slowly increase

Another effective workout is the Straight Knee Eccentric Heel drop:

  • Stand near a stair and use the injured leg to climb
  • ​When you can do it without pain, add weight such as a backpack
  • ​An upgrade to the exercise is the Bent Knee Eccentric Heel drop where you bend the working leg slightly and put your body weight on the injured leg.


Insertional Achilles Tendonitis may be a difficult injury to treat and may take time to heal but it does not mean the end of your running. With a proper understanding of the condition, strict adherence to treatment methods, you can be on your feet in no time.

Do you suffer from Achilles Tendonitis? How long did it take for you to run again? Any other suggestions you would like to share? Please let us know in the comments below.