Abstract
Background: Treatment of insertional achilles tendinopathy is known to be difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy have been proposed as the primary treatments for this condition, but surgery is indicated after failed conservative management. There is no consensus about the most efficient surgical treatment. Objectives: To evaluate a new ultrasound and color Doppler-guided surgical treatment for insertional achilles tendinopathy. Patients and methods: 24 consecutive patients (13 men and 11 women, mean age 47 years) with a long duration of insertional achilles tendon pain (median 18 months) were included in the study. The surgical procedure consisted of extirpation of the subcutaneous and retrocalcaneal bursa, scraping of the ventral distal achilles tendon and removal of prominent bone at the upper calcaneal tuberosity (Haglund’s deformity). In 13 patients, the plantaris tendon was also cut and excised. VAS for pain during activity, satisfaction with the treatment result and the SF-36 score to measure quality of life were used for evaluation. Results: The mean VAS had decreased from 72 before surgery to 19 after surgery (p 0.001), and 20/24 (83%) patients were satisfied with the result and had returned to full tendon loading activity at the one-year follow-up. The SF-36 score had improved significantly. Conclusion: Ultrasound and color Doppler-guided surgical treatment seems to be a good method for treatment of chronic painful insertional achilles tendinopathy. Longer follow-up studies on larger materials are needed.
Highlights
Chronic Achilles tendon pain is a relatively common problem [1], often difficult to treat [2] and occur in both athletes [3] and non-active individuals [4]
It is well known that chronic painful insertional Achilles tendinopathy is difficult to treat, and a range of surgical methods have been presented for this condition
These findings are in line with previous results of biopsies taken from regions with high blood flow in chronic painful midportion Achilles and patellar tendons, where the nerves were located in close relation to blood vessels outside the painful tendons [24]
Summary
Chronic Achilles tendon pain is a relatively common problem [1], often difficult to treat [2] and occur in both athletes [3] and non-active individuals [4]. There is more knowledge about the pathogenesis of the painful midportion achilles tendon, other than about its insertion, but some evidence indicates partially the similar pathology. In both conditions ultrasound (US) with color Doppler (CD) has shown a high blood flow in the painful tendons in contrast to tendons from pain-free individuals [7,8]. Objectives: To evaluate a new ultrasound and color Doppler-guided surgical treatment for insertional achilles tendinopathy. Conclusion: Ultrasound and color Doppler-guided surgical treatment seems to be a good method for treatment of chronic painful insertional achilles tendinopathy.
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