Etiology — what causes it
Load-related changes at the Achilles tendon insertion at the calcaneus. Compression at the bone-tendon interface contributes — explaining the response to heel-raise modifications. May coexist with retrocalcaneal bursitis and Haglund's deformity.
Epidemiology — who gets it
Less common than mid-portion. Often in older runners, those with stiff Achilles, and post-immobilization presentations.
Clinical signs
Tenderness directly at the calcaneal insertion, often with palpable thickening or bony prominence (Haglund's). Pain with passive dorsiflexion at end range.
Symptoms
Heel pain at the back of the foot, worse with hill running, stairs, and deep stretching of the Achilles. Often shoe friction-related.
Best evidence for chiropractic treatment
Jonsson et al. (BJSM) modified the Alfredson protocol — heel-raises from flat ground (avoiding the dorsiflexion portion in early phase) reduce compression at the insertion. Heavy slow resistance approaches with avoidance of deep dorsiflexion follow the same principle. Shockwave has supportive evidence in refractory cases.
When to seek emergency care
Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.
Bottom line
Insertional Achilles needs modified loading — avoid deep dorsiflexion early on. Progressive heel raises from flat ground are the key.