Achilles Tendinopathy & Insertional Heel Pain

Stiffness and pain at the back of the heel — from desk worker to elite runner

Conditions Treated

Neck Pain
Trigeminal Neuralgia
Back Pain
Knee pain
Buttock Pain
Shoulder Pain
Pain Due To Vascular Diseases
Hip Pain
Cancer Pain And Palliative Care

Overview

Achilles tendinopathy is a degenerative condition of the Achilles tendon causing pain, stiffness, and localised swelling at the mid-portion (2–7 cm above the heel) or at the insertional site on the calcaneus. It is the most common lower-limb tendinopathy in runners but increasingly seen in sedentary individuals with metabolic risk factors. Distinguishing mid-tendon from insertional tendinopathy is critical as treatment approaches differ significantly.


Symptoms & Causes

Common Symptoms

  1. Morning stiffness and pain at the back of the heel or just above it
  2. Pain with the first steps after rest — improves with gentle activity
  3. Localised tendon thickening and tenderness (mid-portion: 2–7 cm above heel; insertional: at heel bone)
  4. Pain with calf raises and jumping
  5. Visible swelling along the tendon or at insertion
  6. Crepitus on palpation of the tendon
  7. Painful arc sign (tender nodule moves with ankle plantarflexion in mid-tendon type)
Common Causes

  1. Sudden increase in running mileage or training intensity
  2. Stiff-soled footwear or inadequate heel drop
  3. Tight gastrocnemius-soleus complex
  4. Diabetes, hypertension, obesity — metabolic tendinopathy
  5. Fluoroquinolone antibiotic use (ciprofloxacin, levofloxacin)
  6. Haglund's deformity — bony prominence causing insertional irritation
  7. Pronated foot biomechanics

Conservative & First-Line Treatment

  • Eccentric calf strengthening programme (Alfredson protocol for mid-tendon; modified for insertional)
  • Heel lift inserts to reduce tendon load
  • Activity load management
  • NSAIDs (short-term for pain control)
  • Extracorporeal Shockwave Therapy (ESWT) — strong evidence for mid-tendon type

How Vedant Pain Management Clinic Can Help

Our interventional pain specialists offer the following evidence-based procedures, all performed with real-time ultrasound guidance for precision and safety:

  • Ultrasound-guided PRP injection into the pathological zone of the Achilles tendon — promotes collagen regeneration, avoids fat pad / tendon rupture risk of corticosteroids
  • Ultrasound-guided high-volume injection (HVI) — saline + adrenaline to strip pathological neovascularity (advanced treatment for chronic cases)
  • Ultrasound-guided dry needling / tenotomy of tendon lesions
  • Diagnostic ultrasound to grade tendinopathy, measure tendon thickness, identify partial tears, and assess neovascularity with Power Doppler
  • Retrocalcaneal bursa injection for insertional type with co-existing bursitis
  • IMPORTANT: Corticosteroid injections are avoided into the Achilles tendon due to risk of rupture — PRP and HVI are the preferred options at Vedant Pain Clinic

Newer Diagnostic Concepts & Advances

The 'continuum model' of tendinopathy (reactive → dysrepair → degenerative) guides treatment selection at Vedant Pain Clinic. Power Doppler ultrasound identifying neovascularisation (abnormal blood vessel ingrowth) correlates with severity and pain. High-Volume Injection (HVI) targeting this neovascularisation is now a well-established interventional technique for chronic refractory Achilles tendinopathy.

Frequently Asked Questions

This depends on severity. Mild-moderate tendinopathy can be managed with load modification — reducing speed and hill running — while continuing a graduated eccentric strengthening programme. Complete rest is counterproductive and worsens tendon matrix quality.

Corticosteroids weaken tendon collagen fibres and can cause tendon rupture — a serious complication requiring surgical repair. PRP (which promotes tendon healing) or high-volume injection (which targets neovascularity) are the evidence-based alternatives for Achilles tendinopathy at Vedant Pain Clinic.

Mid-portion tendinopathy (2–7 cm above heel) responds excellently to eccentric loading exercises. Insertional tendinopathy (at the heel bone) has a compressive component — aggressive eccentric heel drops below the step can worsen it. Modified isometric and isotonic exercises are preferred for the insertional type.

PRP delivers concentrated growth factors (PDGF, TGF-β1, IGF-1) directly into the degenerated tendon, stimulating tenocyte activity, collagen synthesis, and angiogenesis. Multiple RCTs show PRP combined with eccentric exercise produces significantly better outcomes than exercise alone for chronic Achilles tendinopathy.

A degenerated Achilles tendon does carry a higher risk of rupture, especially with sudden eccentric load (e.g. jumping, sprinting). Our treatment protocol includes load management advice to reduce this risk while the tendon heals.
Meet Our Specialist

Dr. Mohit Gupta

Interventional Pain Physician & Pain Specialist

Dr. Mohit Gupta is a highly experienced Interventional Pain Physician dedicated to helping patients overcome chronic pain and regain a better quality of life. He combines advanced, minimally invasive pain management techniques with compassionate, personalized care.

10+ Years Experience
Advanced Pain Therapies
Patient-First Care
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Dr Mohit Gupta