Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
Achilles tendinitis near Farmington Hills has two distinct locations — insertional (at the heel bone) and mid-portion (2–6cm above it) — and the treatment that resolves 80% of mid-portion cases actively worsens insertional cases. Identifying which type you have takes 10 seconds on exam and changes the entire rehab approach. Call (810) 206-1402 for Achilles tendon evaluation.
Medically Reviewed by: Dr. Tom Biernacki DPM · Board-Certified Podiatrist · Balance Foot & Ankle PLLC · Updated 2026
Achilles Tendinitis Treatment Near Farmington Hills, MI
Achilles tendinitis (tendinopathy) treatment near Farmington Hills, MI is available at Balance Foot & Ankle in Bloomfield Hills. Dr. Biernacki DPM distinguishes non-insertional (midportion) from insertional tendinopathy — which require different treatments — and manages both with evidence-based eccentric loading protocols, shockwave therapy, and PRP when indicated. Corticosteroid injections directly into the tendon are avoided. Call (810) 206-1402.
Non-Insertional vs Insertional: Why the Location of Achilles Pain Changes Everything
Achilles tendinopathy — commonly called Achilles tendinitis, though “tendinosis” (degenerative change without acute inflammation) is more accurate for chronic cases — is the most common overuse injury of the lower extremity in running athletes, affecting both competitive runners and recreational “weekend warriors.” The most important distinction that changes treatment: non-insertional (midportion, 2-6cm above the calcaneal insertion) vs insertional (at the calcaneal insertion itself). These are clinically, biomechanically, and therapeutically different conditions. Non-insertional tendinopathy (most common): Pain and thickening at the midportion of the Achilles, 2-6cm above the heel. Worsened by running, improved initially with warmup (“start-up pain”), tenderness on direct palpation. The collagen fiber disorganization and neovascularization visible on ultrasound. Responds well to Alfredson eccentric loading protocol. Insertional tendinopathy: Pain at the posterior heel at the tendon insertion. Associated with Haglund deformity (prominent posterior superior calcaneal tuberosity — “pump bump”) causing retrocalcaneal bursitis and direct tendon impingement. Eccentric loading protocol is less effective for insertional — in fact, the Alfredson protocol with heel drops below the step makes insertional tendinopathy worse because it compresses the tendon against the bony prominence. Insertional cases: heel lift + topaz/radiofrequency or surgical debridement + posterior calcaneal exostectomy for refractory Haglund cases. In our Farmington Hills-area practice, the most common error is applying the full eccentric protocol to an insertional case, causing increased pain and patient non-compliance.
Key Takeaway: Non-insertional (midportion): Alfredson eccentric protocol 12 weeks = 80%+ success. Insertional: eccentric below-step protocol makes it WORSE — use heel lift, concentric/isometric loading, shockwave. NEVER inject corticosteroid directly into the Achilles tendon body (rupture risk). PRP evidence is moderate — reasonable for chronic refractory cases. Haglund deformity + insertional pain = surgical consultation if conservative fails 6+ months.
Evidence-Based Treatment Protocol
Non-insertional tendinopathy — Alfredson eccentric protocol: Eccentric heel drops off a step (knee straight = gastrocnemius, knee bent = soleus), 3 sets of 15 repetitions twice daily, 12 weeks. Initial pain with the exercises is expected and should not be a reason to stop. 12-week completion produces 80%+ success. Heel lift (1cm) reduces Achilles tension during activity. Activity modification: continue running at reduced intensity during treatment. Insertional tendinopathy: Heel lift in all footwear to reduce tendon compression against the calcaneus. Soft heel counter shoes (avoid rigid heel cups that press on the Haglund prominence). Concentric and isometric loading instead of eccentric below-step loading. Extracorporeal shockwave therapy (ESWT) — effective for both insertional and non-insertional, particularly for chronic refractory cases. PRP injection: Ultrasound-guided PRP injection into the tendon body — moderate evidence for non-insertional cases refractory to eccentric training. Surgical: Tendon debridement and reconstruction for >50% tendon cross-section involvement. Posterior calcaneal exostectomy + retrocalcaneal bursectomy for Haglund deformity. Absolute contraindication: Corticosteroid injection directly into the Achilles tendon — associated with tendon rupture.
⚠️ See a Podiatrist If:
- Achilles pain not responding to stretching after 4-6 weeks — clinical diagnosis and imaging needed
- Achilles pain with a palpable tender nodule or thickening — degenerative tendinosis, needs ultrasound
- Recent fluoroquinolone antibiotic course with Achilles pain — high tendon rupture risk
- Posterior heel “pump bump” prominence with Achilles pain — Haglund deformity evaluation
- Sudden pain and audible “pop” in the Achilles — rupture evaluation urgently needed
Recommended Products for Achilles Tendinitis Recovery
Achilles tendinopathy is one of the most common conditions we treat — and one of the most responsive to the right combination of load management and support. Dr. Biernacki recommends these products for patients managing Achilles tendinitis between appointments.
Tuli’s Heavy Duty Heel Cups — Achilles Offloading
A heel lift is one of the fastest ways to reduce Achilles tendon load. By raising the heel, you shorten the tendon’s working length and decrease the stretch placed on it with each step. Tuli’s waffle-cup design provides both the lift (3/8 inch) and shock absorption that Achilles tendinopathy patients need. We use these in our clinic as a first-line intervention before prescribing orthotics. Fits most shoes; inexpensive enough to put in every pair.
Strassburg Sock — Achilles & Plantar Fascia Night Splint
Many Achilles tendinopathy patients experience the worst pain with their first steps in the morning — a sign of nocturnal tendon shortening. The Strassburg Sock gently maintains the ankle in a neutral or slightly dorsiflexed position overnight, keeping the Achilles tendon elongated while you sleep. This prevents the microadhesions that cause morning pain and promotes collagen remodeling. Far more comfortable than rigid night splints; most patients adapt within 2–3 nights.
OrthoInfo – AAOS: Achilles Tendinitis
Getting to Our Office From Farmington Hills
Our Bloomfield Hills office at 43494 Woodward Ave #208 is about 15–20 minutes from Farmington Hills via I-696 E to Woodward Ave. We accept most major insurance. Call (810) 206-1402 or book online.
Achilles Pain? Get Expert Tendinopathy Treatment
Balance Foot & Ankle · Serving Farmington Hills & Michigan
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📋 Dr. Tom Biernacki, DPM, FACFAS answers:
Farmington Hills residents have access to our full Achilles tendinitis treatment protocol at our nearby Novi and Auburn Hills offices. We offer eccentric exercise protocols, custom orthotics with heel lifts, MLS laser therapy, EPAT shockwave therapy, cortisone-free PRP injections, and night splinting. Cortisone injections are NOT recommended for Achilles tendinopathy as they increase rupture risk. For mid-substance insertional Achilles tendinopathy that has not improved with 6 months of conservative care, surgical debridement may be considered. Most patients improve significantly within 3 to 4 months of targeted treatment.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.