Treatment of Achilles insertional calcific tendinosis using alongitudinal midline incision approach/central tendon splitting approach

Abstract

Treatment of Achilles insertional calcific tendinosis through alongitudinal midline incision approach with optional resection of the retrocalcaneal bursa and calcaneal tuberosity (Haglund's deformity). Calcific Achilles tendinosis, dorsal heel spur, insertional tendinosis. General medical contraindications to surgical interventions. Fracture, infection. Longitudinal skin incision medial of the Achilles tendon. Exposure and midline incision of the Achilles tendon with plantar detachment from the insertion site preserving medial and lateral attachment. Resection of adorsal heel spur and intratendinous calcifications. Optional resection of the retrocalcaneal bursa and calcaneal tuberosity (Haglund's deformity). Partial weight bearing 20 kg in 30° plantar flexion in along walker boot for 2weeks. Afterwards 2weeks of progressively weight bearing in 15° plantar flexion and another 2weeks in neutral ankle joint position in along walker boot. Atotal of 26feet of 26patients with calcific Achilles tendinosis were treated with midline incision of the tendon. In all feet calcific tendon parts were resected. In10 (38%) feet, aprominent dorsal spur was resected, in 12feet (38%) retrocalcaneal bursa, and in24 (92%) feet acalcaneal tuberosity. Mean follow-up was 34.5months (range2-64months). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 58.2 (±8.1) and postoperatively the score was 22.75 (±6.0). In all, 7 (26.9%) patients stated delayed wound healing; 1suffered from deep vein thrombosis. Shoe problems were reported by 50% of patients, and 23.1% suffered from par- or dysesthesia. No revision surgery was required.