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Patient Info

Surgical Procedures

Achilles Tendon Disorders

The Achilles tendon is the largest tendon in our bodies.  The tendon originates from the calf muscles, gastrocnemius and soleus. The tendon will attach to the heel in a fan shape with the center being the thickest.  Terms used to describe tendon degeneration, include tendonitis and tendonosis.  Tendonitis is specific to tendons that have a sheath, or covering.  Tendonosis, is degeneration of the tendon, typically from overuse.  Some individuals will have bone form in the chronically inflamed tissues.

One of the most common findings, in a variety of foot and ankle disorders, is a tight calf muscle.  A tight calf will greatly change the function of the hip, knee, foot and ankle.  Simple exercises to stretch the calf muscle will alleviate many problems such as plantar fasciitis and Achilles tendonosis.  It is important that the exercises be performed correctly and consistently.

Pump DumpSurgery will be done on the Achilles only after a failure of nonsurgical treatment.  We avoid cortisone injections because of the risk of complete rupture of the tendon.  The most straight-­‐forward of the surgeries is to excise the small bump on the heel known as a pump bump

Sometimes a large bone and soft tissue bump form that is known as a Haglund’s deformity.  The surgery is to detach the Achilles tendon and excise the diseased tendon and bone.  The tendon will be reattached into the heel with metal or plastic screw devices and suture. This surgery may be supplemented with the transfer of healthy tissue, such as the tendon and muscle of the large toe or using platelet rich plasma(PRP).  Blood is removed from a vein and is placed in a centrifuge and then filtered.  The platelets contain a variety of growth factors that may help in the healing.

True Achilles tendonosis is characterized by a painful swelling in the middle of the achilles tendon.  Sometimes it will be warm and soft when examined.  These findings are that of true tendonosis.  Two strategies are used with this presentation.  One is that of limited mobilization and careful physical therapy.  If there is no improvement in 4-­‐6 weeks, then the leg will be immobilized in a cast or cast boot.  Only when there is either worsening or no improvement will surgery be recommended.

If you have any of these problems, the best solution is to seek consultation so a specific treatment plan will be designed for you.

Many patients are interested in the actual surgical procedure.  The next page will have slides from a surgery for chronic Achilles tendonosis that includes the transfer of  the tendon from the large toe(FHL).  If you don't want to see an actual surgery don't proceed.

Bump Achilles Tendon The patient is face down. There is a large “bump” in the achilles tendon.
Bump Achilles Tendon The incision is marked and the arrow points to the diseased tendon.
Bump Achilles Tendon The skin and the paratenon, or covering of the tendon, has been exposed. The arrow points to the large area of disease. Closer to the knee, the transition can be seen of normal and diseased tissue.
Bump Achilles Tendon The tendon has been cut in half. We can clearly see the central degeneration of the tendon. A normal tendon has neatly arranged fibers, like a braided rope.
Bump Achilles Tendon The Achilles tendon has been lifted away to expose the fascia, or thick tissue, covering the deep compartment of the leg. This will be opened to exposed the muscle and tendon to the large toe, flexor hallucis longus.
Bump Achilles Tendon The tendon and muscle are clearly seen. This healthy tissue will be placed in the defect created by the removal of the diseased Achilles tendon.
Bump Achilles Tendon A hole has been drilled into the heel. The tendon to the large toe will be placed into the hole and fixed to it by placing a polymer screw into the hole to hold the tendon in place. This is known as an interference screw.
Bump Achilles Tendon The interference screw is being inserted
Bump Achilles Tendon The tendon to the large toe is now secured to the heel.
Bump Achilles Tendon The achilles is repaired with suture and the large toe tendon is secured to fill in the defect. The deep tissues and skin are then secured in layers. A well padded splint will be applied to protect the repair.

After the surgery it is critical to keep the leg elevated and to use cold. These will reduce pain and swelling. At two weeks, gentle motion will be started. Light resistance exercise begins at 4 weeks and weight bearing is started at 6 weeks. These are only guidelines and individuals will vary in the timing of rehabilitation. It typically takes one year before maximum results are seen.

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Orthopaedic Foot & Ankle Specialist

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Crystal Clinic Orthopaedic Center
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