Achilles insertional tendinopathy - Orthosports
Insertional
Achilles
Tendinitis
Todd
Gothelf
MD
(USA),
FRACS,
FAAOS,
Dip.
ABOS
Foot,
Ankle,
Shoulder
Surgeon
You
have
been
diagnosed
with
Insertional
Achilles
Tendinitis.
The
achilles
tendon
inserts
onto
the
calcaneus
bone
at
the
back
of
the
heel.
Surrounding
this
insertion
are
fluid--filled
bags
called
bursae.
These
bursae
allow
for
the
tendon
to
glide
against
the
skin
and
surrounding
tissues.
Orthopaedic
Surgeons
J.
Goldberg
A.
Turnbull
R.
Pattinson
A.
Loefler
J.
Negrine
I.
Popoff
D.
Sher
T.
Gothelf
Sports
Physicians
J.
Best
M.
Cusi
P.
Annett
Inflammation
can
occur
at
the
insertion
of
the
tendon,
either
in
the
bursa,
or
in
and
around
the
tendon.
This
is
known
as
an
insertional
tendinitis.
The
inflammatory
process
is
commonly
seen
in
runners,
especially
hill
climbers,
and
is
associated
with
a
bump
in
the
bone
of
the
heel,
known
as
a
Haglund
deformity.
Often
the
cause
is
unknown,
progressing
from
heel
pain
to
degeneration
of
the
tendon.
Patients
with
this
condition
will
have
pain
at
the
insertion
of
the
tendon
to
bone.
In
chronic
conditions,
the
tendon
may
be
thickened
and
calcifications
or
bony
spurs
may
be
present.
X--rays
are
important
as
they
can
reveal
a
prominence
of
bone
at
the
heel
and
calcifications
(heel
spurs)
within
the
tendon.
An
MRI
is
useful
to
demonstrate
bursitis
and
the
amount
of
tendon
degeneration.
This
information
is
useful
when
considering
surgery.
160
Belmore
Rd,
Randwick
2031
47--49
Burwood
Rd,
Concord
2137
2
Pearl
St,
Hurstville
2220
1A
Barber
Ave,
Kingswood
2747
Ph
9399
5333
Fax
9398
8673
Ph
9744
2666
Fax
9744
3706
Ph
9580
6066
Fx
9580
0890
Ph
4721
1865
Fx
4721
2832
Initial
treatment
of
this
condition
is
always
non--operative,
as
85
to
90%
of
cases
improve
with
non--surgical
methods.
These
treatments
include
achilles
tendon
stretches,
heel--lifts,
ice,
and
anti--inflammatory
medication.
A
walking
boot
can
also
be
used
to
rest
the
tendon
and
reduce
inflammation.
Physiotherapy
is
vital
to
initiate
these
treatments,
and
I
will
prescribe
therapy
to
someone
who
has
experience
in
the
treatment
of
this
condition.
If
physiotherapy
and
rest
fails
to
help
after
three
to
six
months,
then
surgery
can
be
considered.
Treatment
may
vary
depending
upon
the
extent
of
tendon
involvement.
Generally
speaking,
the
tendon
is
debrided
(cleaned)
of
diseased
tissue
and
bony
prominences
are
removed.
The
tendon
is
then
reattached
with
metal
anchors
and
sutures.
With
extensive
tendon
involvement,
a
healthy
tendon
from
the
foot
(Flexor
digitorum
longus)
is
transferred
to
the
achilles
attachment.
Usually
this
tendon
can
be
sacrificed
without
significant
loss
to
the
normal
functioning
of
the
foot.
The
foot
is
then
protected
in
a
plaster
slab
for
two
weeks.
The
success
of
the
surgery
is
75%.
Surgery
requires
one
night
stay
in
hospital.
A
physiotherapist
will
assist
with
crutch
walking
while
not
allowing
weight
to
be
put
on
the
leg.
When
walking
is
comfortable,
discharge
from
the
hospital
is
allowed.
Prescriptions
for
pain
medications
and
anti--coagulation
medication
will
be
given.
The
anti--coagulation
medication
is
important
to
prevent
blood
clots,
and
will
be
given
until
weight
is
allowed
to
be
placed
on
the
leg,
usually
in
four
to
six
weeks.
I
will
check
the
wound
at
two
weeks
after
surgery
in
my
rooms.
If
the
wound
looks
good
a
boot
will
be
placed
on
the
leg
to
keep
the
tendon
protected.
The
boot
must
be
worn
at
all
times,
except
for
showering,
unless
other
instructions
are
given.
Driving
is
okay
if
the
left
foot
is
the
operated
leg
and
the
automobile
is
an
automatic.
The
RTA
states
that
one
cannot
drive
with
an
injured
foot
or
with
plaster
until
the
foot
is
better.
With
this
procedure,
I
will
not
allow
use
of
the
right
leg
for
driving
until
eight
weeks
after
surgery.
At
that
stage
the
foot
may
be
used
for
driving
when
the
patient
is
comfortable
doing
so.
All
surgery
is
accompanied
by
possible
risks
and
people
can
be
made
worse
by
surgery.
The
complications
of
surgery
include,
but
are
not
limited
to,
anaesthetic
problems,
infection,
bleeding,
blood
clots,
damage
to
nerve,
vessel
or
tendon,
incomplete
relief
of
symptoms
and
recurrence
of
deformity
or
condition.
Any
of
these
complications
may
require
further
surgery.
160
Belmore
Rd,
Randwick
2031
47--49
Burwood
Rd,
Concord
2137
2
Pearl
St,
Hurstville
2220
1A
Barber
Ave,
Kingswood
2747
Ph
9399
5333
Fax
9398
8673
Ph
9744
2666
Fax
9744
3706
Ph
9580
6066
Fx
9580
0890
Ph
4721
1865
Fx
4721
2832
................
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