Achilles' tendon tendinitis and heel pain
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...
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Published in | Operative techniques in sports medicine Vol. 5; no. 3; pp. 179 - 188 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.07.1997
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Abstract | 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. |
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AbstractList | 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. |
Author | Todesca, Andrea Ceciliani, Luciano Benazzo, Francesco |
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CitedBy_id | crossref_primary_10_1111_j_1530_7085_2003_03038_x crossref_primary_10_1046_j_1533_2500_2003_03029_x crossref_primary_10_1016_j_cpm_2004_08_007 crossref_primary_10_1016_j_rcot_2013_03_020 crossref_primary_10_1177_146040869900100401 crossref_primary_10_2106_00004623_200211000_00024 crossref_primary_10_1016_j_fcl_2005_01_010 crossref_primary_10_1177_03635465000280012501 crossref_primary_10_7717_peerj_12166 |
Cites_doi | 10.1177/107110078000100308 10.2165/00007256-198603020-00003 10.1177/036354658100900204 10.1302/0301-620X.62B3.7410468 10.7547/87507315-67-4-280 10.1177/036354658100900104 10.1177/036354658701500403 10.3109/ort.1969.40.suppl-126.01 10.1177/036354657600400404 10.1007/BF00416006 10.1177/036354657900700104 10.2106/00004623-197052010-00001 10.2106/00004623-196547020-00003 10.1055/s-2007-993610 10.1177/036354657600400202 10.7547/87507315-82-9-482 10.7547/87507315-74-3-129 10.1177/036354658401200301 10.1177/036354658901700605 10.1097/00003086-199209000-00026 |
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Copyright | 1997 W.B. Saunders Company. All rights reserved |
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Evaluation of surgical treatment of 18 patients publication-title: J Bone Joint Surg Am doi: 10.2106/00004623-196547020-00003 contributor: fullname: Keek – volume: 4 start-page: 121 year: 1990 ident: 10.1016/S1060-1872(97)80040-8_bib20 article-title: Der terapieresistente fersenschmerz eine Operationsindication der Sporttraumatologie publication-title: Sportverletz Sportschaden doi: 10.1055/s-2007-993610 contributor: fullname: Riel – volume: 4 start-page: 46 year: 1976 ident: 10.1016/S1060-1872(97)80040-8_bib25 article-title: Achilles tendonitis in runners: a report of five cases publication-title: Am J Sport Med doi: 10.1177/036354657600400202 contributor: fullname: Clancy – volume: 82 start-page: 482 year: 1992 ident: 10.1016/S1060-1872(97)80040-8_bib19 article-title: Achilles peritendinitis: a literature review with a case report publication-title: J Am Podiatr Med Assoc doi: 10.7547/87507315-82-9-482 contributor: fullname: Lemm – volume: 22 start-page: 231 year: 1980 ident: 10.1016/S1060-1872(97)80040-8_bib6 article-title: Achilles tendon disorders in runners. 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Snippet | Achilles tendinopathies are one of most common overuse problems seen in athletes. Inflammation or pathologic degeneration of the Achilles tendon itself is one... |
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Title | Achilles' tendon tendinitis and heel pain |
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