Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Insertional Achilles tendinopathy (IAT) — degenerative tendinopathy at the Achilles tendon’s calcaneal insertion (the distal 2cm of the tendon) with associated calcific deposits, posterior calcaneal osteophyte (Haglund’s deformity), and retrocalcaneal bursitis — is pathophysiologically distinct from non-insertional (mid-substance) Achilles tendinopathy and responds less predictably to conservative measures, particularly the eccentric loading protocol (Alfredson drops from a step) which aggravates insertional loading and is contraindicated for IAT. Surgical management for refractory IAT — calcaneal osteotomy, tendon debridement, and when more than 50% of the Achilles insertion requires resection, augmentation with flexor hallucis longus (FHL) transfer — provides 80–85% patient satisfaction when appropriately indicated.

Diagnosis and Conservative Management

Clinical features: posterior heel pain at the Achilles insertion (distinguished from retrocalcaneal bursitis by the pain location — directly at the tendon-bone interface, not in the deeper bursal space); calcification within the Achilles tendon at the insertion on lateral X-ray; posterior calcaneal prominence (Haglund’s deformity); stiffness and pain with initial steps after rest; bilateral in 30% of patients. MRI: insertional Achilles tendinopathy appears as tendon thickening, signal heterogeneity, and calcific deposits at the calcaneal attachment; the extent of tendon degeneration (‘footprint’ involvement) guides surgical planning — >50% insertion involvement requires FHL augmentation. Conservative management: IAT-specific protocol: heel lifts (reduces insertional tension); AVOID eccentric drops from a step (increases insertional loading); isotonic calf strengthening on flat surface; corticosteroid injection into the retrocalcaneal bursa (NOT the tendon) with ultrasound guidance; extracorporeal shockwave therapy (ESWT) — 60–70% improvement for IAT; 6–12 months conservative trial before surgical planning.

Surgical Treatment

Midline posterior approach: central splitting of the Achilles tendon to expose the calcaneal insertion; calcification debridement and resection of degenerative tendon tissue; posterior calcaneal prominence (Haglund) resection with osteotome; retrocalcaneal bursa excision; primary repair of tendon detachment with knotless anchors if <50% insertion involved. FHL tendon transfer (for >50% insertion involvement): FHL tendon harvested just distal to the knot of Henry (preserving IP hallux flexion); tunneled through a calcaneal bone tunnel and sutured to the Achilles stump; FHL provides a robust, vascularized, motor-innervated augmentation for massive insertional tendon defects. Recovery: non-weight-bearing 6 weeks; weight-bearing boot at 8 weeks; full shoes at 12 weeks; return to recreational activity at 5–6 months. Dr. Biernacki at Balance Foot & Ankle performs insertional Achilles debridement and FHL reconstruction at our Bloomfield Hills and Howell offices. Call (810) 206-1402.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

Book Online or call (810) 206-1402

Achilles Insertional Tendinopathy Treatment in Michigan

Balance Foot & Ankle treats insertional Achilles tendinopathy and Haglund deformity with conservative care and surgical debridement with reattachment when needed.

Learn About Our Achilles Tendon Treatments → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. McGarvey WC, et al. Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach. Foot Ankle Int. 2002;23(1):19-25.
2. Nunley JA, et al. Insertional Achilles tendinopathy. Foot Ankle Clin. 2009;14(4):621-642.
3. Maffulli N, et al. Insertional Achilles tendinopathy: state of the art. J ISAKOS. 2021;6(3):162-172.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.