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[Treatment of Achilles insertional calcific tendinosis using a longitudinal midline incision approach/central tendon
Dariusch Arbab1, Bertil Bouillon2, Christian Lüring3
1Orthopädische Klinik, Klinikum Dortmund, Fakultät Gesundheit, Universität Witten/Herdecke, Beurhausstr. 40, 44137, Dortmund, Deutschland. darbab@gmx.de.
Objective:
Treatment of Achilles insertional calcific tendinosis through a longitudinal midline incision approach with optional resection of the retrocalcaneal bursa and calcaneal tuberosity (Haglund's deformity).
Indications:
Calcific Achilles tendinosis, dorsal heel spur, insertional tendinosis.
Contraindications:
General medical contraindications to surgical interventions. Fracture, infection.
Surgical Technique:
Longitudinal skin incision medial of the Achilles tendon. Exposure and midline incision of the Achilles tendon with plantar detachment from the insertion site preserving medial and lateral attachment. Resection of a dorsal heel spur and intratendinous calcifications. Optional resection of the retrocalcaneal bursa and calcaneal tuberosity (Haglund's deformity).
Postoperative Management:
Partial weight bearing 20 kg in 30° plantar flexion in a long walker boot for 2 weeks. Afterwards 2 weeks of progressively weight bearing in 15° plantar flexion and another 2 weeks in neutral ankle joint position in a long walker boot.
Results:
A total of 26 feet of 26 patients with calcific Achilles tendinosis were treated with midline incision of the tendon. In all feet calcific tendon parts were resected. In 10 (38%) feet, a prominent dorsal spur was resected, in 12 feet (38%) retrocalcaneal bursa, and in 24 (92%) feet a calcaneal tuberosity. Mean follow-up was 34.5 months (range 2-64 months). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 58.2 (±8.1) and postoperatively the score was 22.75 (±6.0). In all, 7 (26.9%) patients stated delayed wound healing; 1 suffered from deep vein thrombosis. Shoe problems were reported by 50% of patients, and 23.1% suffered from par- or dysesthesia. No revision surgery was required.
