Surgical Management of Insertional Achilles Tendinopathy with Haglund's Deformity: A Preliminary Report

2010 ◽  
Vol 45 (5) ◽  
pp. 356
Author(s):  
Jun-Young Lee ◽  
Sueng-Hwan Jo ◽  
Hoon Yang
Keyword(s):  
Surgical Management ◽  
Preliminary Report ◽  
Achilles Tendinopathy ◽  
Haglund’S Deformity ◽  
Insertional Achilles Tendinopathy

scholarly journals Outcomes of Operative Management of Insertional Achilles Tendinopathy in the Young vs Elderly

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142092610
Author(s):  
Huai Ming Phen ◽  
Wesley J. Manz ◽  
Danielle Mignemi ◽  
Joel T. Greenshields ◽  
Jason T. Bariteau
Keyword(s):  
Linear Regression ◽  
Wound Infection ◽  
Surgical Management ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Heel Pain ◽  
Complication Rates ◽  
Sf 36 ◽  
Significant Difference ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a common cause of chronic posterior heel pain. Surgical intervention reproducibly improves patients’ pain and functional status. We hypothesized that patients older than 60 years would have similar improvements in pain and function and low rates of complications after surgery for IAT when compared to a younger cohort. Methods: Retrospective review of adult case series in patients undergoing surgical management of IAT. Patients were stratified into those 60 years and younger and those older than 60 years. Patients with prior or concomitant surgical procedures and revisions were excluded. Visual analog scale (VAS), Short Form–36 Physical Component Summary and Mental Component Summary (SF-36 PCS/MCS) scores, wound infection, and recurrence, defined as a redevelopment of heel pain in the operative extremity within 6 months, were assessed with a minimum follow-up of 12 months. Statistical analysis was performed using linear regression mixed models and χ2 analysis. Thirty-seven patients were enrolled, with 38 operative heels. The younger cohort had an average age of 49.1 (range, 26-60) years. The older group had an average age of 66.8 (range, 61-76) years. Results: VAS and SF-36 PCS scores for the entire cohort significantly improved at 6 and 12 months postoperatively ( P < .001). Postoperative SF-36 MCS scores for the cohort significantly improved only at 12 months ( P < .001). No significant differences between the young and elderly were seen with regard to improvements in VAS and SF-36 PCS/MCS at 6 or 12 months postoperatively. Multiple linear regression models showed no significant difference between age groups and VAS score, SF-36 PCS/MCS, or change in pain scores after controlling for comorbidities. No significant difference in overall complication rates was seen between the 2 groups (4.9% vs 29.4%, P = .104). There was 1 recurrence of heel pain in the younger group and 4 recurrences of pain in the older group (23.5%) at 6 months, of which 2 resolved at 1 year. There was 1 case of a superficial wound infection requiring antibiotics in the older cohort (5.9%). No patients required surgical revision. Conclusion: Surgical management of IAT in an older population produced similar improvements in clinical results when compared to a younger cohort, with no significant increase in postoperative complications. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Endoscopic Calcaneoplasty in an Elite Runner

2020 ◽  
pp. 1-3
Author(s):  
Sameh A Labib ◽  
Albert M. Pendelton ◽  
Jessica Y. Labib ◽  
Sameh A Labib
Keyword(s):  
Surgical Intervention ◽  
Weight Bearing ◽  
Achilles Tendinopathy ◽  
Hand Position ◽  
Prospective Analysis ◽  
Direct Visualization ◽  
Before And After ◽  
Haglund’S Deformity ◽  
Insertional Achilles Tendinopathy ◽  
Elite Runner

Haglund’s syndrome is a triad of postero-superior calcaneal prominence, retro-calcaneal bursitis and insertional Achilles tendinopathy. Endoscopic treatment of patients with this triad allows for earlier weight bearing, direct visualization of the Achilles insertion and less soft tissue disruption. In addition, it allows excellent visualization of the pathology. We report a case of an elite runner that underwent Endoscopic Calcaneoplasty done in the prone position. Prospective analysis of his performance before and after the surgical intervention as well as post-operative rehabilitation is detailed. Prone positioning allows for easier accessto the Haglund’s deformity, a more logical view on the monitor and a more ergonomic hand position.

scholarly journals Outcome of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy with and without Haglund’s Deformity

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Ziying Wu ◽  
Wei Yao ◽  
Shiyi Chen ◽  
Yunxia Li
Keyword(s):  
Shock Wave ◽  
Extracorporeal Shock Wave Therapy ◽  
Likert Scale ◽  
Achilles Tendinopathy ◽  
Shock Wave Therapy ◽  
Extracorporeal Shock Wave ◽  
Haglund’S Deformity ◽  
Insertional Achilles Tendinopathy ◽  
Time Point

Purpose.To compare the results of extracorporeal shock wave therapy (ESWT) for insertional Achilles tendinopathy (IAT) with or without Haglund’s deformity.Methods.Between September 2014 and May 2015, all patients who underwent ESWT were retrospectively enrolled in this study. A total of 67 patients were available for follow-up and assigned into nondeformtiy group (n=37) and deformtiy group (n=30). Clinical outcomes were evaluated by VISA-A Score and 6-point Likert scale.Results.The VISA-A score increased in both groups, from49.57±9.98at baseline to83.86±8.59at14.5±7.2months after treatment in nondeformity group (P<0.001) and from48.70±9.38at baseline to67.78±11.35at15.3±6.7months after treatment in deformity group (P<0.001). However, there was a greater improvement in VISA-A Score for the nondeformity group compared with deformity group (P=0.005). For the 6-point Likert scale, there were decreases from3.92±0.80at baseline to1.57±0.73at the follow-up time point in nondeformity group (P<0.001) and from4.0±0.76at baseline to2.37±1.03at the follow-up time point in deformity group (P<0.001). There was no significant difference in improvement of the 6-point Likert scale between both groups (P=0.062).Conclusions.ESWT resulted in greater clinical outcomes in patients without Haglund’s deformity compared with patients with Haglund’s deformity.

scholarly journals Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

2021 ◽  
Vol 7 (1) ◽  
pp. e000979
Author(s):  
Håkan Alfredson ◽  
Lorenzo Masci ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Fatty Infiltration ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Plantaris Tendon ◽  
Medial Pain ◽  
Tendon Insertion ◽  
Insertional Achilles Tendinopathy

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

scholarly journals Up to a quarter of patients with certain chronic recalcitrant tendinopathies may have central sensitisation: a prospective cohort of more than 300 patients

2018 ◽  
Vol 13 (3) ◽  
pp. 137-144
Author(s):  
Patrick C Wheeler
Keyword(s):  
Lower Limb ◽  
Plantar Fasciitis ◽  
Pain Syndrome ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Greater Trochanteric Pain Syndrome ◽  
Duration Of Symptoms ◽  
Central Sensitisation ◽  
Clinical Records ◽  
Insertional Achilles Tendinopathy

Introduction: To identify the possible prevalence of ‘central sensitisation’, in patients with chronic recalcitrant lower limb tendinopathy conditions, with the Central Sensitisation Inventory (CSI) questionnaire. Methods: Patients with chronic lower limb tendinopathy conditions treated within a single hospital outpatient clinic specialising in tendinopathy were identified from clinical records. As part of routine care, self-reported numerical markers of pain, global function (using the EuroQol-5D (EQ-5D) questionnaire) and the CSI score to investigate the possibility of central sensitisation were completed. Results: A total of 312 suitable patients with chronic lower limb tendinopathy and similar conditions were identified, who had completed a CSI questionnaire. Of these, 108 presented with greater trochanteric pain syndrome, 12 with patella tendinopathy, 33 with non-insertional Achilles tendinopathy, 48 with insertional Achilles tendinopathy and 110 with plantar fasciitis. A total of 66% of the patients were female, the median age was 54.9 years and the median duration of symptoms was 24 months. There was a median CSI score of 25%, with statistically significant differences noted between the different conditions studied. Overall, 20% of patients scored above a threshold of 40% on CSI questionnaire, indicating that central sensitisation was possible. Greater trochanteric pain syndrome and plantar fasciitis had the highest proportions in the conditions studied. Weak correlations were found between CSI and other pain scores studied. Conclusion: The CSI questionnaire may identify up to a quarter of patients with some chronic lower limb tendinopathy and associated conditions as being more likely to have central sensitisation, and these proportions differed between conditions. The clinical significance of this is unclear, but worth further study to see if/how this may relate to treatment outcomes. These are results from a single hospital clinic dealing with patients with chronic tendinopathy, and comparison with a control group is currently lacking. However, on the information presented here, the concept of central sensitisation should be considered in patients being treated for chronic tendinopathy.

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