Eccentric or heavy slow resistance loading, modified to avoid end-range dorsiflexion for insertional disease.
Key points
Evidence summary in preparation.
Degenerative pain at the Achilles insertion, often with a Haglund deformity, retrocalcaneal bursitis and intratendinous calcification. First-line care is load management and loading exercise programmes, with extracorporeal shockwave therapy (ESWT) for persistent symptoms. Surgery (debridement, Haglund resection and reattachment, with or without FHL transfer) is reserved for failed non-operative care.
Eccentric or heavy slow resistance loading, modified to avoid end-range dorsiflexion for insertional disease.
Evidence summary in preparation.
Radial or focused ESWT, alone or combined with loading.
Evidence summary in preparation.
Platelet-rich plasma, high-volume or other injectable therapies.
Evidence summary in preparation.
Debridement of degenerate tendon and calcification, Haglund resection, reattachment with anchors, with or without FHL transfer.
Evidence summary in preparation.
| Paper | Year | Design |
|---|---|---|
| Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-Analysis. Korakakis V · J Orthop Sports Phys Ther · 2026 · Systematic review / meta-analysisKey paper | 2026 | Systematic review / meta-analysisLevel I-II |
| Endoscopic versus open surgery for insertional achilles tendinopathy: A systematic review and meta-analysis of comparative outcomes. Chen PY · J Exp Orthop · 2025 · Observational / otherKey paper | 2025 | Observational / otherLevel III-IV |
| Surgical treatment of insertional Achilles tendinopathy: a systematic review. Traina F · J Biol Regul Homeost Agents · 2016 · Systematic review / meta-analysisKey paper | 2016 | Systematic review / meta-analysisLevel I-II |