Achilles tendon enthesopathy is pain where the Achilles tendon attaches to the back of the heel bone.
People typically feel pain at the back of the heel when walking.
Diagnosis includes an examination of the tendon and sometimes x-ray.
Stretching, night splints, and heel lifts may help.
(See also Overview of Foot Problems.)
The cause of Achilles tendon enthesopathy is chronic traction (pulling) of the Achilles tendon where it attaches to the heel bone. Contracted or shortened Achilles tendon caused by being sedentary and overweight or caused by athletic overuse increase the risk. Occasionally, people with Achilles tendon enthesopathy have arthritis elsewhere (spondyloarthritis).
Use of antibiotics called fluoroquinolones increase the risk of Achilles tendinitis and rupture of the tendon especially in people over age 60.
Typically, people feel pain at the back of the heel below the top of the shoe when walking.
Diagnosis of Achilles Tendon Enthesopathy
A doctor's examination
The diagnosis of Achilles tendon enthesopathy is based on a physical examination of the tendon. The diagnosis is confirmed if people have tenderness of the tendon where it attaches to the heel bone. Manually bending (flexing) the ankle upwards during the examination usually makes the pain worse.
Treatment of Achilles Tendon Enthesopathy
Stretching, night splints, and heel lifts
If present, treatment of spondyloarthritis
Doing exercises that stretch the calf muscles for 10 minutes 2 to 3 times daily can help people with Achilles tendon enthesopathy. A person can stretch the calf muscle and Achilles tendon while facing a wall at arms’ length, with the knees straight and the foot bent upward.
To minimize stress to the Achilles tendon when walking, the foot and ankle should be moved actively through the ranges of motion for about a minute when rising after long periods of rest.
Night splints may also be used to stretch the tendon during sleep and help prevent the calf muscles from becoming too tight.
Heel lifts are used temporarily for both feet to relieve pain, decrease stress on the tendon, and correct abnormal motion of the hip or back while walking.
For people with Achilles tendon enthesopathy related to an underlying spondyloarthritis, a nonsteroidal anti-inflammatory drug (NSAID) or another type of medication (a biologic agent such as a TNF inhibitor) may help.
Doctors may consider extracorporeal pulse activation therapy (EPAT), also known as extracorporeal shockwave therapy (ESWT), for people whose enthesopathy is difficult to heal. In this therapy, doctors use a device to apply pressure waves of sound to the heel. The pressure waves stimulate blood circulation, which may help healing.
