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Achilles tendon enthesopathy is pain at the insertion of the Achilles tendon at the posterosuperior aspect of the calcaneus.
The cause is chronic traction of the Achilles tendon on the calcaneus. Contracted or shortened calf muscles (resulting from a sedentary lifestyle and obesity) and athletic overuse are factors. Enthesopathy may be caused by a spondyloarthropathy.
Pain at the posterior heel below the top of the shoe counter during ambulation is characteristic. Pain on palpation of the tendon at its insertion is diagnostic. Manual dorsiflexion of the ankle during palpation usually exacerbates the pain. Recurrent and especially multifocal enthesitis should prompt evaluation (history and examination) for a spondyloarthropathy.
Treatment
Physical therapy aimed at calf muscle stretching should be done 10 min three times/day. The patient can exert pressure posteriorly to stretch the calf muscle while facing a wall at arms' length, with knees extended and foot dorsiflexed. To minimize stress to the Achilles tendon with weight bearing, the patient should move the foot and ankle actively through their range of motion for about 1 min when rising after extended periods of rest. Night splints may also be prescribed to provide passive stretch during sleep and help prevent contractures. Heel lifts should be used temporarily to decrease tendon stress during weight bearing and relieve pain. Heel lifts should be used bilaterally to prevent gait disturbance even if pain is only in one heel.
Last full review/revision March 2008 by Kendrick Alan Whitney, DPM
Content last modified March 2008
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