Experience with surgery for insertional achilles pain?

I have no solution for you unfortunately but I have had a similar issue to you. Mine started in 2022, I’ve been able to race and PR with it but the pain is always there, some days are worse than others and afternoon running is significantly better than morning running. Heel raises seem to curtail it, and I have good days and bad days. The weird thing is if I take time off the pain is completely gone after like two days. To this day I don’t know if it’s bursitis or insertional achilles tendinitis, as both feel similar. Best of luck. I guess the silver lining is that you can run at a high level with this injury but I’ve yet to find anything to completely make it go away.

I had haglunds removed from both heels a few years apart. They did not need to detach the achilles. Best thing I ever did. Took rehab a little more conservatively the first time and was running in 12 weeks. After the second one, I took my first run at 8 weeks.

I struggled for years with horrible insertional tendonitis, and didn't get surgery. It has gone away 98% to the point where it doesn't affect my training besides here and there I'll call off the last rep in a sprint workout if I feel it starting to tug a little. But it was a seriously brutal injury for a couple years, to the point of not being able to stand for long on it, and having to use crutches sometimes. All standing, walking, and running was painful.

And I do have haglunds. Weirdly though, my haglunds is actually sharper on the side that DOESN'T have insertional tendonitis, so I don't think addressing the haglunds is necessarily the key here. It just took years of slow progression with strengthening and mobility (at some point...you do have to stretch it I believe). I do a night wrap of arnica and Voltaren (wrapped with plastic wrap) around my heel if it acts up, and that helps. You might want to try that for a couple weeks, it helped me cope with the pain of stretching it.

Now I keep it healthy with flexible shoes and 'barefoot' running (Vibrams or turf) a couple times a week.

Another comment from one who hasn't had surgery.

I suppose I've had a Haglund's deformity for a long time (always?) but it never bothered me until July 5, 2025, when I stupidly did a 20-mile training run the day after a 5-mile 4th of July race during which my right calf cramped pretty badly. The 20-miler went fine, but within a few hours my right Achilles began to hurt and by the next morning I could hardly walk. I missed the marathon I was training for, missed months of training, and saw several orthopedists, all of whom told me I needed surgery. I wasn't keen on losing close to a year to Achilles surgery at age 57 so I decided to try to manage it non-surgically.

It took me a couple of years to figure it out, but for the past 8-9 years I have never been sidelined by the Achilles and usually have only minor pain--enough to remind me all is not well, but not enough to interfere with anything I want to do. For me, the secret was to never wear footwear that puts any pressure on the back of the heel except when running. All of my non-running shoes are either sandals or ex-running shoes with the back of the heel cut out completely. And I run only in shoes that have the softest, most flexible heels I can find. My foot can handle 1-2 hours/day of heel pressure but not much more.

I know people who have had the surgery and it basically works, but the recovery is very long, on the order of 1 year. I've chosen the conservative route and it's working for me.

I second all of this. Funnily enough my issue also started in the week after a race where my calf seized up really bad, and I did have a couple calf strains prior. (My take for anyone reading who doesn't have achilles issues is: calf issues are a warning that your achilles is about to go!! Adjust load and or footwear and or strengthening to save years of suffering!)

And yeah, ditching shoes that put pressure on the heel is an absolute must. No more heel counters, even after recovery.

I had the surgery after yrs of pain and swelling, never looked back and I have no limitations.

I did NOT have the tendon removed from the calcaneus. The physician cut down the boney growth, removed the retrocalcaneal bursa and debrided the tendon. I deep water ran for 3 months and started back running with zero pain. No PT needed.

I'm 33 and have been managing this pain for 10+ years. I am finally seeing and orthopedic surgeon in a few weeks to get some imaging and assess my options. I've been able to run fairly high mileage and have had some fast race results but it is now limiting my training and ability to be a functional human outside of training, ha! Things that have helped manage my pain:

- Calf and hip strengthening

- Foot mobility ~ I use the sidekick tool axis board daily

- Red light therapy ~ I use a device from kineon and this has helped a ton

- Shoes without a stiff heel counter and higher drop ~ unfortunately these are hard to come by these days.

- Modifying training ~ rest days, less doubles, more XT. Unfortunately this has negatively impacted my race results.

While all of these have helped me continue to run, there is still a large bump on each heel that will cause pain until they are removed. I recently ran a 5k race and was in pain the rest of the day limping around like I had run a marathon! Such a frustrating injury and I wouldn't wish it on anyone.

I finally broke down and had the surgery. Same issues as you, it would get better but keep coming back. First instance was early 40s, surgery 5 years later or so. What a mistake. I was on a knee scooter for almost a year with all sorts of issues immediately afterwards, plantar facia issues so bad I couldn't put weight on my heal, nerve pain, cold foot, etc. Pretty sure it would have healed on its own if I was off of it for a year. Try nitroglycerin patches. They have worked for me with the other heel. I'd be wary of surgery, my doc was supposedly an expert... I still have minor issues but not with the achilles, but the nerves haunt me still on occasion. With that said, I'm running pretty hard on it at post 60, (sub 18 3mile, 530 mile for what it's worth.)

See, that’s where I feel like my issue isn’t actually Haglund’s related, because it never feels like pressure on the back of the heel causes pain. It’s just that when it flares up, putting any sort of weight on that tendon causes pain. Sometimes it’s bad enough that I can’t push up on my left foot to stand on my toes.

Anyway, it’s interesting to hear everyone’s experiences, and I’m somewhat surprised they’re mostly non-surgical so far. I feel like I’m in a similar boat as y’all, with similar exercise and PT, helping me run with minimal pain most of the time.

Keep those stories coming!