Pain relief seen with combined surgical options for insertional Achilles tendinosis
All patients reported that they would have the surgery again and recommend it to others.
SAN DIEGO A surgical treatment for insertional Achilles tendinosis that combines various procedures used for this condition demonstrated efficacy and significant pain relief at a mean of 2 years postoperatively.
For 5 years, Thom A. Tarquinio, MD, has used the procedure that combines excision of the postero-superior calcaneal prominence or Haglunds deformity, excision of the insertional calcaneal osteophyte, Achilles debridement and a gastrocnemius fascia release.
Images: Ferguson CA
Tarquinio, Christopher A. Ferguson, MD, and their colleagues evaluated 25 patients who underwent this procedure between May 2002 and October 2005. All patients previously failed conservative treatment.
This is a technically simple procedure, it gives reliable, consistent results [and] it provides excellent pain relief, Ferguson said at the American Orthopaedic Foot and Ankle Society Specialty Day Meeting, held here.
Investigators lost three patients to follow-up and one patient declined to participate, leaving 21 patients with 22 treated feet, Ferguson said. This patient group included 18 women and 3 men. Patients were a mean age of 57 years and had a mean body mass index of 34.74.
Investigators performed chart reviews on all patients, conducted telephone interviews with five patients, and administered American Academy of Orthopaedic Surgeons Foot and Ankle questionnaires to 16 patients. Physical therapists also evaluated those 16 patients for postoperative range of motion, Ferguson said.
The surgical technique involved two posterior midline incisions with the patients in the prone position.
Ferguson said they performed a gastrocnemius fascia release (Vulpius technique) to protect the insertion during the healing phase, to avoid avulsion, and to decrease pain.
Surgeons then made a distal incision down through the Achilles tendon and debrided the medial half of the tendon.
We dont actually detach the entire tendon, so this avoids the use of bone anchors, Ferguson said. We are able to remove the posterior calcaneal osteophytes and resect the retrocalcaneal bursa, and excise the Haglunds exostosis.
Ferguson said that surgeons then debrided the lateral half of the Achilles tendon, and finally closed the wound with buried Vicryl sutures (Ethicon). At an average 21.8-month follow-up, patients rated their pain an average 1.5 on a 10-point scale significant relief compared to the preoperative 8.95, Ferguson said, with 52% of patients having reported complete pain relief.
Physical therapy evaluation found an insignificant difference in postoperative range of motion between the operative and nonoperative sides, with the operative side at a mean 4.07° less than the nonoperative, Ferguson said.
Investigators found a significant difference in postoperative strength between the two sides, however. Measured by standing single-leg heel lifts, patients were able to perform a mean 4.67 out of 5 on the nonoperative side compared to 1.8 on the operative side.
These are heavy, low-demand patients and all but one patient did not even know they were weak until the time of the evaluation, Ferguson said. The patients were essentially unable to bear weight on their affected foot prior to surgery because of pain and all were able to resume their precondition level of activity after surgery.
All patients reported that they would have the surgery again and would recommend it to family and friends, Ferguson said.
Thirteen of the patients were very satisfied, five were somewhat satisfied, two were neutral and only one patient, our sole workers compensation patient, was very dissatisfied.
For more information:
- Christopher A. Ferguson, MD, can be reached at the University of Mississippi Medical Center, 2500 N. State St., Jackson, MS 39216; 601-984-6525; e-mail: email@example.com. He has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.
- Ferguson CA, Tarquinio TA, Wingerter S, Ware N. Results of surgical treatment of insertional Achilles tendinosis. Presented at the American Orthopaedic Foot and Ankle Society Specialty Day Meeting. Feb. 17, 2007. San Diego.