Insertional Tendinitis of the Tendo Achilles

Minimally invasive surgeries for insertional Achilles tendinopathy: A commentary review

Studies of minimally invasive surgery for insertional Achilles tendinopathy are limited. To establish this surgery, the following techniques must be minimally invasive: Exostosis resection at the Achilles tendon insertion, debridement of degenerated Achilles tendon, reattachment using anchors or augmentation using flexor hallucis longus (FHL) tendon transfer, and excision of the posterosuperior calcaneal prominence. Studies on these four perspectives were reviewed to establish minimally invasive surgery for insertional Achilles tendinopathy. Techniques for exostosis resection were demonstrated in one case study, where blunt dissection around the exostosis was performed, and the exostosis was resected using an abrasion burr under fluoroscopic guidance. Techniques for debridement of degenerated Achilles tendon were demonstrated in the same case study, where the space left after resection of the exostosis was used as an endoscopic working space, and the degenerated Achilles tendon and intra-tendinous calcification were debrided endoscopically. Achilles tendon reattachment techniques using suture anchors have been demonstrated in several studies. However, there are no studies on FHL tendon transfer techniques for Achilles tendon reattachment. In contrast, endoscopic posterosuperior calcaneal prominence resection is already established. Additionally, studies on ultrasound-guided surgeries and percutaneous dorsal wedge calcaneal osteotomy as minimally invasive surgery were reviewed.

Insertional Achilles Tendinopathy

Posterior heel pain is a common condition of the foot and ankle and is seen in a variety of foot types. Nonoperative treatment methods consisting of shoes inserts, heel lifts, stretching, physical therapy, nonsteroidal antiinflammatory drugs, eccentric strength training, and other modalities have been shown to have mixed results. When indicated, surgical repair can produce good long-term results. Complications, although uncommon, most commonly result from wound healing complications.

Surgical correction of Haglund's triad using complete detachment and reattachment of the Achilles tendon

Haglund's triad consists of the simultaneous presentation of the following clinical entities: Achilles tendinosis, Haglund's deformity, and retrocalcaneal bursitis. In this retrospective study, we review outcomes following the surgical treatment of Haglund's triad by means of complete detachment and reattachment of the Achilles tendon, removal of the retrocalcaneal exostosis, and excision of the retrocalcaneal bursa through a medial J-shaped approach. Patients were identified via chart review, and sent consent forms and a questionnaire consisting of a visual analog scale (VAS), a satisfaction survey, and the Maryland Foot Score. Seventeen patients (22 feet) met the inclusion criteria and returned the consent and questionnaires. Their mean age was 51.6 +/- 11.6 years, and the mean duration of postoperative follow-up was 40.1 +/- 27.0 months. The mean preoperative VAS was 7.9 +/- 2.3, and the postoperative VAS was 1.6 +/- 1.3 (P < .001). The mean postoperative Maryland Foot Score was 91.5 +/- 9.1, with 16 good to excellent results. Of the 17 patients, 16 were satisfied and only 1 was somewhat unsatisfied. Four complications were observed, and 1 of these required further surgical intervention. The outcome of this study demonstrated that surgical correction of Haglund's triad using a medial "J" approach, complete detachment and reattachment of the Achilles tendon, exostectomy, and retrocalcaneal bursectomy provided patient satisfaction with limited complications.

LEVEL OF CLINICAL EVIDENCE

4.