Insertional Achilles Tendon Injuries in the Athlete

Insertional Achilles tendon injuries are common among running and jumping athletes of all age ranges. Injuries to this site are often due to an overuse mechanism and are especially common in individuals who continue to participate in sports into middle age and beyond. They present with a broad spectrum of severity and chronicity from mild acute tendonitis to partial or complete tendon rupture. The causes of injuries and conditions of the distal Achilles tendon are often multifactorial and may include biomechanical factors, training errors, and medications that predispose the tendon to degeneration or tear. It is this variability of cause, severity, and chronicity coupled with many athletesʼ unwillingness to alter or curtail the inciting activity that makes determination of an ideal treatment option a challenge. Nonsurgical management, which may consist of oral nonsteroidal anti-inflammatory medications, physical therapy, shoewear modification, and training alterations, has been the mainstay of treatment for patients with tendon inflammation and early degeneration. However, when injuries become more chronic and debilitating or when complete rupture occurs at the calcaneal insertion, debridement to remove degenerative tissue and repair using a calcaneal anchor-based suture bridge are required. Augmentation of the repair with transfer of the flexor hallucis longus tendon may be required if more than 50% of the tendon has been damaged or if extensive debridement leads to inadequate tendon length. Recently, biological treatment options as well as less invasive procedures have become available for stimulating tendon healing.