Retrocalcaneal exostosis. Anatomy and a new surgical approach

Various procedures have been described for removing a retrocalcaneal exostosis. These procedures require partial or complete detachment of the insertion of the Achilles tendon and ultimate resection of the exostosis. The authors introduce a simplified technique to surgically excise a retrocalcaneal exostosis based on an important and newly reported anatomical relationship. The procedure is performed through a posterior transverse incision and requires little or no reflection of the Achilles tendon. Overall, the 14 patients studied retrospectively wore shoes and returned to usual activities fairly rapidly after this procedure; however, time until patients were free of pain averaged nearly 12 months. Two patients did not obtain relief and required additional surgery despite complete removal of the exostosis. These results challenge the assumption that retrocalcaneal pain is secondary to exostosis formation.