Achilles Insertional Calcific Tendinosis

Achilles Insertional Calcific Tendinosis (AICT)

Uncommon symptomatic and degeneration with calcification of achilles insertion  posterior heel pain

Aetiology:
Unclear, but a common factor is a calcaneal ‘shelf’ (posterior projection of middle part of posterior calcaneus at insertion of achilles  possibly changes lever arm and tension vector if achilles tendon); increased risk associated with other factors commonly associated with overuse sports injuries.

Clinical features:
Gradual onset; usually no history of trauma; pain after arising from rest/sleep; pain on activity; may be slight swelling; pain localised to achilles insertion area on palpation; visible on lateral x-ray.

Staging :
Stage 0 – no pain
Stage 1 – pain on palpation, but no pain on activity and minimal discomfort after activity
Stage 2 – transient pain/stiffness with initiation of activity, pain after activity
Stage 3 – pain at beginning, during and after activity
Stage 4 – unable to perform desired activity

Differential Diagnosis – Haglund’s deformity; bursitis (painful in footwear); achilles insertional tendonitis; sural nerve entrapments; calcaneal apophysitis; stress fracture; rheumatological disease

Management:
ICE after activity; activity modification; NSAID’s; heel lift; physical therapy – soft tissue mobilisation; stretching & strengthening – especially eccentric strengthening; foot orthoses (?); night splints; surgical (removal of tendon  resect calcification  reattach tendon more plantarly.