Persistent heel pain may be due to Achilles tendon insertion problems.
Swelling and pain where the achilles tendon inserts can occur either as a result of an injury, or a gradual onset of symptoms from what is suspected to be multiple small injuries that just don’t get better.Â
It is quite disabling and the swelling at the back of the heel can rub against shoes making the pain worse.Â
We always start with a period of non-operative therapy, with specific stretches, physiotherapy, dry needling, and a small heel insert. Platelet Rich Plasma injections are also indicated if these initial measures aren’t helpful.Â
If after several months of non-operative therapy the symptoms persist, then we can discuss whether a surgical solution is warranted. There are 2 main procedures we can do depending on the condition, varying from taking a small wedge out the heel to decompress the tendon, or removing the prominent bone and inflamed tissue, and re-suturing the tendon down with bone anchors. Rehabilitation involves being in a moon boot for a few weeks, and physiotherapy for 2-3 months.
