Mid-portion vs insertional achilles tendinopathy
Achilles tendinopathy can be described as mid-portion or insertional tendinopathy. What differentiates these two classifications is simply the location at which the tendon is affected.
Insertional Achilles tendinopathy is characterised by pain at the back of the heel bone where the tendon attaches to the calcaneus. It will often feel like the pain is in the heel bone itself. Insertional forms of Achilles tendinopathy are commonly associated with compressive loads and forces. The compressive loads and forces can be in the form of compression from the heel counter of footwear, compression of the tendon from the heel bone itself during maximal dorsiflexion of the foot (when the foot is bent upwards) and both the magnitude of force and tendon strain associated with an activity.
Mid-portion achilles tendinopathy is tendinopathy of the mid to higher portion of the tendon that sits adjacent to the prominent tibia and fibula heads (also known as the medial and lateral malleoli). It is characterised by stiffness and pain in these areas after rest and localised swelling. Activity that involves high amounts of tensile loading through the Achilles tendon (such as long distance running & jumping activities) is often associated with mid-portion achilles tendinopathy. Age, foot biomechanics and gross loading are additionally associated with tendinopathy in this area of the Achilles.
Treatment
Though Mid-portion and insertional Achilles tendinopathies often present with similar symptoms and are only a few inches apart in location, treatment for each is very specific and needs to be tailored. The key differences in treating these two forms of tendinopathies are seen mainly in exercise prescriptions. Due to insertional forms of tendinopathy being mostly caused by compressive forces, exercises that put the foot in full dorsiflexion or full plantar flexion will likely aggravate the injury rather than resolve it.
Treatment options for either injury can include; Load management, footwear modifications & orthotics, shockwave therapy, strength programs, taping and manual therapies. Progression through the phases of tendinopathy rehab may involve functional strengthening, correction of dysfunctional movement, power training, plyometrics to engage a stretch-shortening cycle in the Achilles tendon and sport-specific rehab.
What to do from here?
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