Insertional Tendinopathy Research Articles

Comparison of open and endoscopic techniques of isolated calcaneoplasty in the surgical treatment of insertional tendinopathy of the Achilles tendon

IntroductionInsertional Achilles tendinopathy (IAT) is primarily caused by mechanical overload. Running and obesity are major risk factors. Medical treatment is limited, and surgery, particularly calcaneoplasty, is sometimes necessary. However, the choice between an endoscopic and open approach remains controversial. HypothesisThis study is based on the hypothesis that endoscopic surgery would allow for better functional recovery with a faster return to sports activity compared to traditional open techniques. Materials and methodsOur multicenter prospective study compared the outcomes of endoscopic (Endo) and open (Open) calcaneoplasty in patients with IAT resistant to medical treatment. Clinical outcomes were assessed using the EFAS (daily life and sports) and VISA-AF scores. The radiological criteria studied were the calcaneal slope and the X/Y ratio. An MRI was used to quantify tendon involvement. ResultsOf the 85 patients included, 51 underwent endoscopic surgery, and 34 had open surgery. The two groups were comparable in terms of demographic, clinical, and radiographic characteristics. At 3 months postoperatively, significantly more patients had returned to sports in the Endo group (41.6% vs. 20.6% in the Open group; p = 0.004), and the EFAS sports score showed a significant difference in favor of the Endo group at 6 months postoperatively (9.3 vs. 5.7 / 16; p = 0.008). DiscussionThe results confirm faster recovery after endoscopic surgery, with comparable complication rates between the two approaches. However, long-term, the differences between the two techniques diminish, with similar functional outcomes at 12 months postoperatively. ConclusionEndoscopic calcaneoplasty is a safe and effective option for the treatment of IAT. However, further studies with longer follow-up are needed to confirm these results and assess recurrence rates. Level of evidenceIII.

Single-Row Repair Versus Double-Row Repair in the Surgical Management of Achilles Insertional Tendinopathy: A Systematic Review.

Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair. To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes. Systematic review; Level of evidence, 3. A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies-of Interventions and risk-of-bias tool for randomized trials tools. A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; P = .01) and mean peak load (433.9 N vs 212 N; P = .042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs. Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes.

Strength and Functional Outcomes Following Achilles Tendon Reconstruction With Hamstring Tendon Autograft Augmentation.

The proposed advantages of hamstring autograft reconstruction when compared to alternative procedures, such as flexor hallucis longus (FHL) transfer, V-Y lengthening, and allograft reconstruction, are improved healing and reproduction of normal tendon biomechanics and reduced morbidity within the foot and ankle. In this study, we examined the effect of Achilles tendon reconstruction using hamstring autografts on strength and functional outcomes. Patients who underwent Achilles repair with a hamstring autograft for insertional or midsubstance tendinopathy, delayed diagnosis of rupture, or infection after primary repair were evaluated for inclusion. Forty-six patients were identified; 12 further augmented with an FHL transfer are included in the analysis. Isokinetic testing was completed with a Biodex dynamometer under supervision of a physical therapist masked to surgical side. Pre- and postoperative Foot and Ankle Outcome Scores (FAOS, before March 2016) or Patient-Reported Outcomes Measurement Information System (PROMIS, after March 2016) surveys were collected. For knee flexion, peak torque was not significantly different when comparing operative and nonoperative sides at 180 degrees/second (45.38 Nm vs 45.96 Nm; P = .69) nor at 300 degrees/second (44.2 Nm vs 47.02 Nm; P = .069). Knee extension absolute peak torque was only found to be significantly weaker on the operative side at the faster testing (75.5 Nm vs 79.56 Nm; P < .05). Peak ankle plantarflexion torque was significantly weaker on the operative side at both the slower speed (60 degrees/second: 39.9 Nm vs 48.76 Nm; P < .005) and the faster speed (120 degrees/second: 31.3 Nm vs 40.7 Nm; P < .001). Average power for ankle plantarflexion did not differ significantly from the operative side to the nonoperative side in the slower test (26.46 W vs 27.48 W; P = .60) but did significantly differ on the faster test (32.13 W vs 37.63 W; P = .041). At an average of 19.9 months postoperation, all physical function and pain-related patient-reported outcome scores showed clinically and statistically significant improvement. Achilles reconstruction with a hamstring autograft ± FHL transfer allowed patients with severe Achilles pathology to return to good subjective function, with modest deficits in calf strength compared with the uninjured side. Overall knee flexion strength did not appear impaired. These results suggest that hamstring autograft reconstruction is a viable method to treat these complex cases involving a lack of healthy tissue, allowing patients to return to symptom-free physical function and athletic activity. Level IV, case series.

EFFECTIVENESS OF ULTRASOUND GUIDED PLATELET RICH PLASMA INJECTION IN COMPARISON WITH EXTRACORPOREAL SHOCK WAVE THERAPY ON IMPROVING PAIN AND FUNCTION IN PATELLAR TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Patellar Tendinopathy is an insertional tendinopathy of the extensor apparatus of the knee that affect athletes practicing several sports at every level of participation but is found mainly in elite athletes involved in jumping activities. The characteristic complaint is an anterior knee pain with insidious onset, localized in the involved area. Diagnosis is clinical and is typically based on medical history and clinical findings. Many methods to treat Patellar Tendinopathy have been evaluated, and there is no true consensus on the most efficacious treatment strategy. Objectives: To determine the effectiveness of ultrasound guided platelet rich plasma injection in comparison with extracorporeal shock wave therapy on improving pain and function among athletes with Patellar Tendinopathy. Study Design: Randomized controlled trial Methods: Forty-four athletes with patellar tendinopathy meeting the inclusion and exclusion criteria were selected for this study and randomized into 2 treatment groups: autologous PRP injections under ultrasound guidance (PRP group n = 22), and 3 sessions of focused extracorporeal shock wave therapy (ESWT group n = 22). The outcome measures were Victorian Institute of Sports Assessment–Patella (VISA-P) questionnaire and pain visual analog scale (VAS). For descriptive statistics mean, standard deviation and frequency were used. Continuous variables were analysed by students t-test. Categorical variables were analysed using Chi-square test. Within the group comparison (baseline and follow-up data of each group) was done by Repeated measures ANOVA. Between the groups comparison was analysed using students t-test. A p-value &lt;0.05 was taken as significant. Results: The 2 groups were homogeneous in terms of their baseline characteristics like age, gender, duration of symptoms and side of affection. Within group comparison showed statistically significant improvement in VISA-P score and reduction in VAS from baseline at all follow ups (p=0.00) in the PRP group. While in the ESWT group, maximum improvement was seen from baseline to 1st follow up at 4 weeks (p = 0.01). However subsequent follow up showed reduction in VISA-P Scores and increased VAS but remained above the baseline values and it was statistically significant (p &lt; 0.05) (Table III). Conclusion: Ultrasound guided injection of platelet rich plasma lead to significant improvement in pain and function over the long term in comparison with focused ESWT in the treatment of patellar tendinopathy in athletes and thereby enabling faster return to sports.

Sagittal Orientation and Variabilities of the Anatomical Insertional Footprint of the Achilles Tendon: A Cadaveric Study

Category: Hindfoot; Sports Introduction/Purpose: New surgical techniques for Achilles tendon insertional pathology are evolving rapidly. Whether via open surgery, minimally invasive, or endoscopic approaches, more information about the Achilles' insertional footprint is needed to help surgeons with decision making. This study investigated the footprints of the Achilles insertion in sagittal orientation to delineate the anatomical landmarks, safe zones for bone resection3-down surgeries in treating insertional Achilles tendinopathies. Methods: Twenty fresh frozen cadavers were selected excluding insertional Achilles tendon pathology on lateral view x-rays. The calcanei were dissected maintaining the Achilles tendon insertion intact. Dimensions of the posterior tuberosity were recorded and marked to plan for three sagittal cuts (medial, middle, and lateral) (Fig 1 A). Using an oscillating saw (Fig 1 B.), the posterior tuberosity was cut into four pieces (Fig 1 C,E). A trapezoid shape (Fig 1 D) was reconstructed demonstrating relative location of the footprints of the Achilles insertion compared to the boundaries of the tuberosity on each piece (A, most superior point in the posterior tuberosity; B, most superior point in the Achilles insertion; C, most inferior point in the Achilles insertion; D, most inferior point in the posterior tuberosity). Data regarding footprints of the Achilles tendon insertion in the sagittal orientation was analyzed and compared within each trapezoid region and among different regions. Results: AB (calcaneal tuberosity tip to the upper limit of the Achilles insertion) was shortest at the medial cut (9.35mm) and longest at the lateral cut (12.15mm). However, the tendon thickness at the insertion (the distance from the proximal to the distal limits) represented by BC was shortest at the lateral cut (13.19mm) and longest at the middle cut (14.04mm). AD, the distance from the highest to the lowest point of the calcaneal tuberosity, was the longest at the middle cut (41.20mm). AB:BC ratio was highest at the lateral cut and lowest at the medial cut, indicating the safe amount of bone to be resected at the Achilles insertion. Tendon thickness relative to the whole calcaneal tuberosity (BC:CD) was highest at the medial wall (Table1). Conclusion: The sagittal orientation and variability of the Achilles tendon insertion is an under-studied topic in the literature. It needs to be addressed given recent trends towards minimally invasive procedures in treating insertional Achilles pathology. This study precisely delineated the footprint in each region of the insertion by creating a trapezoid pattern to compare the coordinates across these areas. This could lead to future three-dimensional reconstruction of the Achilles insertional footprint and patient- specific instrumentation software directed towards optimizing the management of Insertional Achilles pathology.

Achilles tendon pathologies

Achilles tendon pathologies are afrequent problem in the clinical practice. Adistinction must be made between insertional and noninsertional tendinopathies. In addition to intrinsic risk factors, such as diabetes mellitus, there are also extrinsic risk factors, such as overuse and running. Sonography, X‑ray imaging and magnetic resonance imaging (MRI) are established imaging methods, depending on the question. The primary treatment includes aconservative approach. First-line treatment includes administration of nonsteroidal anti-inflammatory drugs (NSAID), physical rest and the use of assistive devices. Established conservative treatment procedures include eccentric stretching, shockwave therapy and infiltration with, e.g., platelet-rich plasma. There are numerous other conservative treatment options. After exhausting the conservative treatment options, asurgical approach can be considered. The surgical procedure depends on the clinical symptoms and findings. Established procedures are minimally invasive or endoscopic procedures or even open debridement.

Surgical Treatment of Haglund's Disease: About 9 Cases

Haglund's disease is a rare disease of the hindfoot, linked to a morphological anomaly of the calcaneus postero-superior tuberosity, causing pre and retro-Achilles bursitis and insertional tendinopathy. The purpose of our work is to analyze the functional results according to long-term resections of the posterosuperior tuberosity of the calcaneus, specifying the radio-clinical and therapeutic aspects of this pathology. Our study is a retrospective study of nine cases of Haglund's disease operated in the Department of Orthopedic and Traumatology at the Ibn Sina hospital in Rabat, between 2019 and 2023, correlated with a simple literature review. The average age of our patients was 41 years old with a male predominance. All our patients showed painful retrocalcaneal swelling. The diagnosis was confirmed by radiological explorations (standard radiography and MRI). After failure of medical treatment, surgery consisted in an open resection of the postero-superior tuberosity of the calcaneus. The evolution was favorable in 92% of cases. Complications were rare. Haglund's disease is a pathology often underestimated, we must think about it before all Achilles insertion tendinopathy. Resection of the tuberosity is a simple technique, with undeniable effectiveness, and which is considered the best treatment.

Insertional Footprint of Achilles Tendon on Calcaneal Tuberosity in South Indian Population: A Cadaveric Study

Abstract Background: Pathologies related to the Achilles tendon (AT) and its insertion are a very prevalent problem. A thorough understanding of its anatomy would assist us to develop and fine-tune treatment options for the same. Hence, a study was done to identify the anatomical footprint of the insertion of AT on the calcaneal tuberosity (CT). Methodology: A cadaveric study was conducted, in which 27 human lower limbs (18 cadavers) were dissected to determine the insertion site of all three fascicles of the AT on the CT. The width of the insertion and thickness of the AT 1 cm proximal to the insertion were also calculated. Results: Rotation of AT, presence of three individual fascicles for each muscle belly, and insertion of these fascicles were consistent throughout the 27 lower extremities dissected. The average width of its insertion is 26.62 mm, with a standard deviation (SD) of 1.98 mm. The average thickness of the AT 1 cm proximal to the insertion was found to be 8.06 mm with a SD of 2.18 mm. Conclusion: These findings are of worth to the ankle and foot surgeons for a better understanding of the insertional tendinopathies and partial thickness tears of AT to design better surgical options for its repair and modulate the conservative management in terms of physiotherapy to the South Indian population.

Treatment of Achilles insertional tendinopathy: our surgical procedure and medium-term results.

Achilles insertional tendinopathy (AIT) is a common injury and its pathogenesis is still not entirely clear. It manifests with worsening pain and functional limitations. When conservative treatment fails, surgical treatment is indicated. The purpose of our research is to evaluate the outcome after one year in patients affected by AIT (calcific and non-calcific AIT) who were treated at our centre. Between 2014 and 2021, 42 patients suffering from AIT - a total of 47 feet - underwent surgery at our centre. The patients filled in the VISA-A and AOFAS questionnaires at the pre-operative consultation and at the clinical check-up after one year of follow up. Of the 47 feet treated, 28 were calcific AITs treated by medial access and tendon reinsertion using a knotless double suture anchor system (Achilles Suture Bridge™) and 19 were non-calcific tendinopathies treated using a lateral paratendinous approach. The one-year clinical results show an increase in VISA-A scores of 48.6 and AOFAS scores of 44.1 and the absence of complications. Only one patient reported a recurrence of certain symptoms and none of the patients were hospitalized for recurrence. The literature is unable to establish a gold standard of treatment for AIT. The method we have used has shown excellent short- and medium-term results without any complications. Further studies are needed to prove its effectiveness in the long term.

Cortical Desmoid of the Distal Femur-Incidentaloma or Insertional Tendinopathy?

The cortical desmoid (DFCI) of the posteromedial femoral condyle is considered an asymptomatic incidental finding in adolescents without clinical relevance. The aim of this study was to evaluate the clinical relevance of DFCI from both a tumor orthopedic and sports medicine point of view. n = 23 patients (13.74 ± 2.74 years; nineteen female, four male) with DFCI of the posteromedial femoral condyle were included. A localized posteromedial knee pain on exertion was differentiated from non-specific knee pain. Symptom duration, additional pathologies, number of MRIs, sports activity and training intensity, downtime, therapeutic modalities, and relief/remission of symptoms were documented. The Tegner activity scale (TAS) and Lysholm score (LS) were collected. The influence of specific posteromedial pain, MRI presence of paratendinous cysts, sports level as well as physiotherapy on downtime and LS/TAS was statistically analyzed. 100% reported knee symptoms at initial presentation. A localized posteromedial pain was documented in 52%. In 16/23 (70%) additional functional pathologies were diagnosed. Patients were physically highly active with high training intensities (6.52 ± 5.87 h/week) and performance level (65% competitive vs. 35% recreational). Patients underwent 1.91 ± 0.97 MRIs (max four). Symptom duration was 10.48 ± 11.02 weeks. A follow-up examination was performed after 12.62 ± 10.41 months (n = two lost to follow-up). 17/21 had physiotherapy, on average 17.06 ± 13.33 units. Overall downtime was 13.39 ± 12.50 weeks, the return-to-sports (RTS) rate 81%. 100%/38% reported a relief/remission of complaints. LS was 93.29 ± 7.95, median TAS before onset of knee complaints/at follow-up 7 (6-7)/7 (5-7). Specific posteromedial pain, presence of paratendinous cysts, sports level and physiotherapy had no significant influence on downtime and outcome parameters (n.s.). DFCI as a pathognomonic finding is recurrently encountered in the MRIs of children and adolescents. This knowledge is essential to spare patients from overtreatment. Contrary to the literature, the present results implicate a clinical relevance of DFCI particularly in those who are physically highly active with localized pain on exertion. Structured physiotherapy as basic treatment is recommended.

Cadaveric and Ultrasound Validation of Percutaneous Electrolysis Approach at the Distal Biceps Tendon: A Potential Treatment for Biceps Tendinopathy.

Distal biceps brachii tendinopathy is a musculoskeletal pain condition-comprising chronic intrasubstance degeneration with alterations of the tendon structure-that is difficult to treat. Preliminary evidence suggests a positive effect for pain and related disability of percutaneous electrolysis treatment in patients with tendinopathy. Ultrasound is an excellent diagnostic tool to identify tendon injuries, such as tendinopathy, and to guide treatment approaches. Different approaches using ultrasound evaluation of the biceps tendon have been described. Our aim was to determine the validity and safety of a percutaneous electrolysis approach, targeting insertion of the distal tendon of biceps brachii, in both human (ultrasound-guided) and Thiel-embalmed cadaver (not ultrasound-guided) models. There were two approaches evaluated: an anterior approach with the elbow in extension and the forearm in supination and a posterior approach with the elbow in flexion and the forearm in pronation. A needle was inserted following the tendon up to its insertion into the radial tuberosity. The anterior approach, both in cadaveric study and US-guided intervention, revealed a close relationship between the distal biceps tendon and the brachial artery. The mean distance of the depth of the biceps tendon distal to the brachial artery was 0.21 ± 0.021 cm in the cadavers and 0.51 ± 0.024 cm in subjects. It was also found that the anterior approach has a potential technical difficulty due to the anatomical location of the brachial artery. With the posterior approach, it was possible to safely identify the tendon insertion and the needle approach, since no important vascular and nervous structures were visualized in the window of insertion of the needle. The clinician rated the posterior approach as low difficulty in all subjects. Current results would support a posterior approach with US guidance as a safe approach for applying the percutaneous electrolysis technique for insertional tendinopathies of the distal biceps brachii tendon. The current study did not assess the effectiveness of the proposed intervention; accordingly, future studies investigating the clinical effectiveness of the proposed intervention are needed.

Surgical treatment of calcifying insertional Achilles tendinopathy via alateral approach

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.

Calcaneal osteotomy due to insertional calcaneal tendinopathy: preoperative planning

PurposeDorsal closing wedge calcaneal osteotomy (DCWCO) is indicated in patients with insertional tendinopathy of the calcaneal (Achilles) tendon. The Chauveaus-Liet’s (CL) angle is represented by the difference between the angle of verticalization (α) and morphological angle (β) of the calcaneus (CL angle = α − β). The purpose of the study was to assess whether the DCWCO affects the Chauveaus-Liet’s angle.MethodsThe study included 12 patients indicated to DCWCO. Three directions of close wedge osteotomy were designed for each patient—horizontal, vertical and in the middle type of osteotomy and a virtual osteotomy was created in each of them in the ABAQUS system in cooperation with Czech Technical University. The most used directions of osteotomy according to the available literature were used. We evaluated α and β angles before and after osteotomy, changes of the length plantar aponeurosis and the elevation of distal insertional point of the calcaneal tendon. The changes of grades, median and standard deviation were observed.ResultsThe change of the alfa angle was dependent on the direction of the osteotomy and the change of the beta angle was affected by the size of the osteotomy. The greatest elevation of the distal insertional point of the calcaneal tendon occurred in the horizontal type of the osteotomy.ConclusionOur study shows that the more we want to reduce the tension in the calcaneal tendon, the more we have to perform an osteotomy horizontally. This study could serve as a preoperative guide for osteotomy planning.

“Double-Row” Suture for Achilles’ Tendon Insercional Tendinopathy Reattachment and Two Types of Rehabilitation Protocol: A Retrospective Comparative Study

Category: Hindfoot Introduction/Purpose: The purpose of this Study is to evaluate the results of knotless double-row sutures for Achilles insercional tendinopathy reattachment and compare two types of post-operative rehabilitation protocols. Methods: This is a retrospective comparative study of collected data from patients who were treated in two different hospital by two different surgeons. Sixty-three (63) patients (66 feet) were included and separated in two different groups. All of them were submitted to the same technique for knotless double-row suture for Achilles insercional tendinopathy reattachment. Group 1 was treated with a functional rehabilitation at the end of a 4 weeks NWB period and group 2 with early and aggressive functional post- operative management. Results: We found that both types of post-operative regimen generate significant improvement in pain and functional scores. Regarding pain, both rehabilitation protocols generated similar results, with no statistically significant differences. However, the FAAM-AVD score, on average, of patients in Group 1 was slightly higher than that of patients in the Group 2. This means that more than 50% of patients in the group 1 had a higher FAAM-AVD than all patients in the group 2. Regarding the comparison of the postoperative rehabilitation of the groups, a more accentuated improvement was observed in the group where functional rehabilitation was postponed to the 5th post-operative week, and the patients having remained immobilized for 4 (four) weeks in a NWB suropodalic orthosis on the operated limb. Conclusion: The double-row suture system for Achilles' reattachment is an excellent option for the surgical treatment of insertional Achilles' tendinopathy. The functional outcome of patients who were submitted to a 4-week delayed functional rehabilitation program is slightly better than those submitted to an early and aggressive functional rehabilitation program.

Plantar Fasciopathy - Pathophysiology Diagnostics and Therapy - A Clinical Guideline

Plantar Fasciopathy - Pathophysiology Diagnostics and Therapy - A Clinical Guideline Abstract. Plantar fasciitis (often referred to as "heel spurs") is a common problem in daily practice. Approximately 4-10% of the general population is affected, in athletes the prevalence is even higher with an estimated prevalence of 5-18%. Heel pain is one of the most common running injuries. Besides runners, overweight individuals exposed to several hours of standing or walking daily are also at risk. The reduction in quality of life can be considerably high. The diagnosis can usually be secured by means of a targeted anamnesis and clinical examination, backed up by ultrasound examination or MRI. The most common differential diagnoses are irritation of the Baxter's nerve, tarsal tunnel syndrome, and insertional tendinopathy of the Achilles tendon. Plantar heel pain is a domain of conservative therapy, surgical procedures are very rarely required. The basic therapy consists of patient education and stretching exercises, it can be expanded by low dye taping, insoles, and extracorporeal shock wave therapy. If this does not lead to a significant improvement in symptoms, night splints and infiltrations can be useful.

The Cincinnati incision is safe and effective for revision surgery for insertional tendinopathy of the Achilles tendon

The present study reports the outcomes of revision surgery using a Cincinnati incision with tendon debridement and calcaneoplasty for insertional Achilles tendinopathy (IAT) in a cohort of patients at 24-month follow-up. Patients undergoing revision surgery following failed previous surgery for IAT were prospectively recruited. Patients were assessed pre-operatively and at 3, 6,12 and 24 months. The Victorian Institute of Sport Assessment Scale for Achilles Tendinopathy (VISA-A), the EQ5D questionnaire and the visual analogue scale (VAS) were used for evaluation. Data from 33 patients with a mean age of 43.9 years old are reported. 27% (9 of 33 patients) were female. The left side was involved in 58% (19/33) of patients. No clinically relevant complications were reported in any of the patients. Most of subscales of EQ5D improved at last follow-up: Usual Activities (P = 0.01), Mobility (P = 0.03), Pain/Discomfort (P = 0.001), Thermometer (P = 0.04). No statistically significant change for the subscales Self-Care (P = 0.08) and Anxiety-Depression (P = 0.1) was evidenced. The VISA-A score improved significantly at last follow-up (P < 0.0001), as did the VAS score (P < 0.0001). These results indicated that a Cincinnati incision followed by tendon debridement and calcaneoplasty for revision surgery for IAT is feasible and reliable, achieving clinically relevant improvement in the VISA-A, EQ5D and VAS at 24 months follow-up.

Tendopathy of the elbow joint

Tendopathy at the point of attachment of the tendons to the bone (insertional tendinopathy) is a consequence of typical overload injuries and is observed mainly in athletes. It is known that the same load can lead to both positive adaptation with tendon hypertrophy and its subsequent strengthening, and dystrophic changes in the area of attachment with a decrease in tendon strength.

Differentialdiagnose dorsaler Fersenschmerz

Heel pain is a common complaint with a prevalence of 15%. Besides inflammatory, infectious, neuropathic or tumor associated causes of pain, a mechanical bony or soft-tissue related disorder can be identified in most cases. Implementing a successful therapy can be challenging due to the variety of clinically similar differential diagnoses. Degenerative pathologies of the Achilles tendon frequently cause posterior heel pain and are subdivided into insertional tendinopathy (often associated with dorsal heel spurs) and mid portion tendinopathy, which is situated in a hypovascular ”critical zone” 2 to 6cm proximal to the calcaneal insertion site. Other typical disorders causing dorsal heel pain are retro-calcaneal or retro-Achilles bursitis, bony deformities (Haglund́s Syndrome), accessory ossicles (Os trigonum), calcaneal apophysitis (Severˊs disease) or flexor hallucis longus entrapment. A thorough physical examination and imaging diagnostics with sonography and MRI are crucial to identify the cause of pain. The therapy includes a wide range of conservative and surgical options depending on the main pathology.

Diagnosis of the Achilles Insertional Tendinopathies by Algometry

Category:Ankle; HindfootIntroduction/Purpose:Diagnosis of Achilles insertional tendinopathies (AIT) is based on pain by tendon palpation. However, there is no consensus or standard regarding the amount of force to be used during the evaluation. The algometry is a method of measuring the pressure applied in a specific region and can be a method for determining diagnosis values. Goal: To determine a cut-off value for Pain Threshold (PT) in the assessment of AIT.Methods:Design: This is a prospective case-control study of diagnostic accuracy, to develop a diagnostic criterion. Methods: Forty asymptomatic individuals and forty patients with insertional Achilles tendinopathy, matched by age and sex, were evaluated, and submitted to algometry for PT and for Visual Analogical Scale (VAS) levels with 3kg/f at the insertion of the calcaneal tendon by two different evaluators. Inter-observer reproducibility was accessed through the interclass correlation index (ICC). Sensitivity and specificity calculation of PT and of VAS were calculated and plotted on a ROC (Receiver Operator Characteristic) curve.Results:The lowest ICC found was 0.788. Regarding the diagnosis through TP, the 4.08 kg/f mark showed the best relation between sensitivity and specificity (92.5% and 92.5%, respectively). Algometry values lower than 4.08 were considered positive for disease. For the diagnosis of TIA through VAS with 3kg/f, the value of 2.98 was determined (sensitivity of 92.5% and specificity of 97.5%).Conclusion:This study showed that algometry is a reliable method in the assessment of Achilles insertional tendinopathies, having a high intra-observer reproducibility. The painful threshold for establishing the diagnosis of Achilles insertional tendinopathies was 4.08 kg/, with values below this number considered altered.

Insertional tendinopathy of the Achilles tendon. Treatment from start to finish

La tendinopatía insercional del tendón calcáneo es un trastorno frecuente, asociado con el aumento de la edad y con los microtraumatismos repetidos por el sobreuso del tendón en pacientes con factores predisponentes. La presencia de lesiones en las bursas, la formación de calcificaciones y las lesiones en la estructura del propio tendón son características. La mayoría de los estudios disponibles sugieren que los pacientes con tendinopatía insercional deben tratarse de inicio con medidas conservadoras, durante un periodo de 3 a 6 meses, entre las que se incluyen un programa de ejercicios dirigidos, la terapia con ondas de choque extracorpóreas de alta energía y el tratamiento de fisioterapia. Los tratamientos quirúrgicos incluyen actuaciones de desbridamiento y resección de bursas inflamadas, de tejido sinovial hipertrófico, de calcificaciones insercionales, del tejido degenerativo intratendinoso, la resección de prominencias de la tuberosidad posterior y la reinserción del tendón de Aquiles. Las complicaciones postoperatorias no son infrecuentes y los problemas de cicatrización de las heridas son una de las complicaciones más comunes. El tratamiento quirúrgico de la tendinopatía insercional del tendón de Aquiles resuelve con frecuencia el dolor y mejora la funcionalidad. La rehabilitación completa puede alcanzarse hasta un año después de la intervención.