Surgical treatment of calcifying insertional Achilles tendinopathy via alateral approach

Abstract

Reduction of pain and swelling over the Achilles tendon insertion while maintaining function. Strong, intolerable pain over the Achilles tendon insertion with chronic, calcifying insertional tendinopathy that does not respond to non-operative treatment over aminimum of 6months. Chronic wounds or severe circulatory deficits at the foot or ankle, irradiating or projected pain, complex regional pain syndrome (CRPS). The intratendinous heel spur is resected via alateral approach. The superior surface of the calcaneal tuberosity is trimmed by resection of the dorsal heel spur with the oscillating saw. Asecond osteotomy at the medial edge of the tuberosity extends to the insertion of the plantaris tendon. With the third osteotomy, the Haglund deformity is resected. At the resulting area with cancellous bone, the Achilles tendon is reinserted with asuture anchor. Aventral plastic splint in 20° plantar flexion is worn for aweek. Full weight-bearing is allowed in awalking boot with 4 cm heel lift for 6weeks. The heel lift is then gradually reduced for another 2weeks. After 8weeks only an elastic wedge of 1 cm is worn. Physical therapy (isometric exercises) starts in the boot and is intensified after removal of the boot. Seven of 12patients treated with that technique for calcifying insertional Achilles tendinopathy (58%) stated being pain free according to the Likert scale, while the remaining 5patients (42%) reported a"substantial improvement". The VISA‑A score averaged 84 of 100points. Postoperative complications have not been observed.