What is Non-Insertional Achilles tendinopathy?
This is a condition where the Achilles tendon becomes inflamed and often degenerate within the main body of the tendon. It is most commonly seen in individuals who exercise or those who have a previous injury to the tendon.
What are the symptoms of Non-Insertional Achilles Tendinopathy?
Pain is usually worse first thing in the morning or after periods of rest. It is often associated with a swelling of the tendon at the site of pain. It can be very debilitating and prevent the individual from exercising. It can cause a limp in severe cases.
How is Non-Insertional Achilles Tendinopathy diagnosed?
Clinical examination by a foot and ankle specialist is the key to an accurate diagnosis. Ultrasound scans and MRI can be very helpful in confirming the diagnosis and helping to plan rehabilitation.
How is Non-Insertional Achilles Tendinopathy treated?
Most individuals will recover well with the help of a physiotherapist. In addition to general foot and ankle rehabilitation, the physiotherapist will look at calf tightness as this has been shown to be a big driver of the symptoms. If a patient remains tight in the calf and symptomatic despite physiotherapy, a small procedure on the back of the calf called a proximal medial gastrocnemius release can take away tension in the calf and significantly improve symptoms.
Injection therapy can also play a role. A high volume injection around the tendon can break down early scar tissue and significantly improve symptoms. Shockwave therapy is a successful treatment if the above treatments have not given significant symptom improvement.
Surgery to the back of the heel is the last resort but may well be necessary if symptoms persist despite a combination of the above treatments.