The Achilles tendon inserts on a broad footprint across the middle third of the posterior calcaneal surface, with the retrocalcaneal bursa between the tendon and the calcaneus at the superior calcaneal prominence. Insertional Achilles tendinopathy involves degeneration within the tendon at the insertional zone and is distinct from mid-portion tendinopathy in both pathology and treatment. The Haglund deformity (posterosuperior calcaneal prominence) compresses the retrocalcaneal bursa and insertion.
Transmits plantarflexion force to the calcaneus; the insertion footprint spans the middle third of the posterior calcaneal surface
Insertional Achilles tendinopathy produces heel pain at the tendon-bone junction that is worsened by shoe counter pressure and activity. Unlike mid-portion tendinopathy which responds to eccentric loading, insertional tendinopathy is aggravated by eccentric exercises that compress the insertion against the calcaneus. Isometric loading in a non-compressive position and shockwave therapy are the preferred non-operative treatments. Haglund resection with debridement of calcification within the tendon is performed for refractory cases.
Tendon degeneration at the calcaneal insertion with associated Haglund deformity and retrocalcaneal bursitis, managed with isometric loading and shockwave before surgical debridement.
