Achilles Tendon Attachment Pain

Achilles tendon

Pain located on the back and bottom of the heel can be caused by inflammation at the attachment of the Achilles tendon.

Diagnosis

Achilles tendon

X-rays will sometimes show a calcification beginning within the tendon insertion (left, white arrows on the X-ray).  The pain may be at this point and lower on the back and bottom of the heel. High resolution ultrasound imaging can be done in the office and may reveal disorganization present within the tendon.

Treatment

Custom molded shoe inserts or orthotics, stabilize the side-to-side motion of the foot and help the tendon insertion heal naturally. Orthotics ordered by a podiatrist for medical necessity are covered by most medical insurance.

A night splint can also prove helpful. The splint is worn for thirty minutes, with minimal but constant tension on the Achilles tendon. Decrease in the "First Thing in the Morning" pain is usually noticed immediately.

A removable walking cast with inflatable air bellows may be used for the first two or three weeks of treatment. This becomes especially necessary and helpful if Achilles tendon damage is seen on ultrasound. The correctly inflated air bellows make a more exact fit and transfer weight away from the injured heel to the surface of the leg. The cast is removed for sleeping, showering and driving. Generally, patients go to work and function normally.

Transition from cast to orthotic

By the time the cast comes off, orthotics normally have come back from the lab.

Posted by Mark A. Kuzel, DPM, FACFAS on September 3, 2010