Achilles' tendon tendinitis and heel pain

• Published in: Operative techniques in sports medicine Vol. 5; no. 3; pp. 179 - 188
• Main Authors: Benazzo, Francesco, Todesca, Andrea, Ceciliani, Luciano
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.07.1997
• Subjects: Achilles' tendon surgery; heel pain; overuse injury; heel pain; overuse injury; Achilles' tendon surgery
• DOI: 10.1016/S1060-1872(97)80040-8
• ISSN: 1060-1872

Achilles tendinopathies are one of most common overuse problems seen in athletes. Inflammation or pathologic degeneration of the Achilles tendon itself is one of the causes of heel pain. In those athletes, refractory to nonoperative management, a surgical treatment is indicated in order to increase the likelihood of reaching preinjury activity levels. Circulatory, metabolic, and mechanical factors are involved in the pathogenesis of the alteration of tendons and peritendinous layers. We distinguish clinically, instrumentally (ultrasonography, computed tomography, and magnetic resonance imaging), and histologically the following clinical and anatomopathologic forms of Achilles tendinopathy: acute peritendinitis, chronic peritendinitis, peritendinitis with tendinosis, tendinosis, insertion tendinopathy, and peritendinitis of the entire tendon with insertion tendinopathy. Our experience has resulted in standardization of the surgical techniques used for the different types of Achilles tendinopathy. In chronic peritendinitis, we can adopt different techniques based on the extension of the adhesions and the thickening of the paratenon, removing the shoots and/or the fibrotic rinds of the fascia, the hypertrophic parts of the paratenon except the ventral fibrous shoots. In peritendinitis with tendinosis, and in simple tendinosis, we make the tendon free from fibrotic adhesions and we may remove degenerated nodules. Longitudinal scarifications are performed to re-establish tendon nutrition. Moreover, in order to improve the blood supply in greatly degenerated tendons we propose the placement of muscle tissue (an isolated bundle of soleus) within the tendon. In insertion tendinopathy the inflamed preachilles bursa is removed together with the proximal and lateral-medial outgrowth of bone and cartilage of the posterior border of the calcaneus. The same treatment is reserved to a true Haglund deformity. The smoothened border no longer impinge the tendon insertion. In our opinion is possible to obtain a good clinical result and a resumption of sport at competitive level with a timely and precise surgical treatment.