What is Insertional Achilles Tendinopathy

Insertional Achilles Tendinopathy is an injury to the Achilles tendon which includes thickening of the tendon and pain (usually a sharp pain just above the heel) is felt during running [1]. Keep in mind that the thickening of the tendon is NOT due to inflammation.

Insertional Achilles Tendinopathy in Runners

Past reports found no inflammatory cells associated with the swelling of the tendon, rather a disordered arrangement of certain collagen fiber types [2]. Another important point to mention is that since there’s no inflammation present, ice therapy and anti-inflammatory meds are ineffective.

What is Insertional Achilles Tendinopathy

Gait retraining, particularly at the foot strike level, seems to be the best therapy and preventative measure for Achilles injury. If you are a heel striker, than heel striking is probably the main reason for your Achilles tendon injury. One study found that heel striking causes a heel whipping motion which leads to changes in ankle moments that causes Achilles injury.

Another way heel striking causes Achilles tendon injury is due to increased work at the hip during the propulsive phase. This has negative implications for the Achilles tendon because the hips are overworked when used aggressively for propulsion during heel strike running. The result, the ankles pick up the slack for when the hips fatigue, which could strain the Achilles immensely.

You also need to stop wearing cushioned running shoes as these shoes not only encourage heel striking, but prolongs foot  pronation and forces the foot into extreme, unnatural positions that can harm the Achilles. Instead, wear flat minimalist running shoes because the absence of compressible midsole cushioning allows for better landing stability which removes stress from the ankles and Achilles.

Overall, the instructions to prevent running related Achilles tendon injuries and to put you on a faster path to recovery is simple: land with a forefoot strike and wear zero-drop minimalist shoes during running.  Here are 2 other ways to improve your forefoot running technique to prevent Achilles tendon injuries.

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More From Run Forefoot:

Forefoot Running  – If you love to run, you’ll love it even more if you run with a forefoot strike.

Barefoot Running – Discover how much better you’ll run forefooted by running shoeless.

Injury – Overwhelmed with pain and injury? Here’s why you keep injuring yourself when running.

Improve Your Race Time – Tips on how to boost endurance for running.


[1]. Smith et al. Neuromotor control of gluteal muscles in runners with Achilles tendinopathy. Med Sci Sport Exerc, 2014;46(3):594-599.

[2]. Kahn et al. The painful nonruptured tendon: clinical aspects. Clin Sports Med, 2003 (22):711-725

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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