From the Guidelines
The X-ray findings show no plantar calcaneal spur but reveal a small enthesophyte (bone spur) at the Achilles tendon insertion on the posterior calcaneus, indicating Achilles tendinopathy with calcification at the tendon-bone junction, and treatment should focus on reducing inflammation and pain while promoting healing. The condition likely represents a response to chronic tension or inflammation at the tendon insertion point, representing the body's attempt to strengthen the attachment, though it can become a source of pain and irritation.
- Key aspects of treatment include:
- Rest from aggravating activities
- Ice application for 15-20 minutes several times daily
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) for 1-2 weeks to reduce inflammation, as suggested by 1 and 1
- Gentle stretching exercises for the calf muscles and Achilles tendon, performed 2-3 times daily, holding each stretch for 30 seconds
- Supportive footwear with adequate heel cushioning and possibly heel lifts to reduce tension on the Achilles tendon
- Physical therapy may be beneficial for persistent symptoms, and it is essential to consider the patient's overall health and activity level when developing a treatment plan, as noted in 1. I recommend a conservative approach as the initial treatment strategy, given the potential benefits and lower risks compared to surgical interventions, which may be considered if conservative measures fail, as discussed in 1.
From the Research
Impression and Findings
- The impression indicates no plantar calcaneal spur, but a small enthesophyte at the Achilles insertion on the posterior calcaneus.
- This finding is relevant to insertional Achilles tendinopathy, a condition where the Achilles tendon inserts into the calcaneus bone.
Treatment Options
- Conventional physical therapy, including gastrocnemius, soleus, and hamstring stretches, ice massage, and use of heel lifts and night splints, has been shown to be effective in treating insertional Achilles tendinopathy 2.
- Eccentric training has also been investigated as a treatment option, but its effect on insertional Achilles tendinopathy is inconclusive 2.
- Nonoperative management techniques, including changing the pathophysiologic process and halting inflammatory changes, are also discussed in the literature 3.
- Endoscopic treatment of insertional Achilles tendinopathy has been explored as a feasible option, allowing for complete resection of the enthesophyte and posterosuperior calcaneal prominence, and satisfactory reinsertion of the tendon 4.
Exercise and Rehabilitation
- Eccentric exercise has been shown to be effective in improving pain and function in patients with mid-portion Achilles tendinopathy, and may also be beneficial for insertional Achilles tendinopathy 5.
- Manual therapy, including joint mobilization and manipulation, has been used in conjunction with eccentric exercise to improve foot and ankle mobility, decrease pain, and improve function in patients with Achilles tendinopathy 6.