Insertional Achilles Tendinopathy Surgery | Results

What is insertional Achilles tendinopathy?

It is pain and thickening where the Achilles tendon attaches to the back of the heel bone. It is common in active people in middle age. Often there is a bony bump (Haglund’s deformity) and an inflamed fluid sac (bursa) rubbing on the tendon.

Most people improve with physiotherapy, activity changes and shockwave therapy. Surgery is considered when pain persists after at least six months of this.

The operation

Through a cut down the back of the heel, the tendon is split and partly lifted off the bone. The damaged tendon, the bony bump and the bursa are removed. The tendon is then reattached with a double-row anchor technique, which spreads the hold over a wider area of bone.

Recovery

Because the repair is strong, we can get people moving early:

1. Cast for 2 weeks, not putting weight on the foot.
2. Walking boot from 2 weeks, starting to take weight.
3. Physiotherapy from 6 weeks.
4. Return to sport from 12 weeks, as comfort allows.

What our study found

We reviewed 50 consecutive patients treated at Guy’s Hospital between 2013 and 2020, followed for an average of 2.4 years.

• Foot pain and function scores (MOXFQ) improved from 48 to 12, where lower is better.
• Patients’ rating of their overall health rose from 48 to 84 out of 100.
• No tendon ruptured or pulled off the bone, despite early walking.
• Four patients (8%) had a minor complication: two superficial wound infections and two cases of short-lived nerve pain. None changed their recovery.
• Results were similar in patients over and under 50.

Reference: Lewis TL, Srirangarajan T, Patel A, Yip GCK, Hussain L, Walker R, Singh S, Latif A, Abbasian A. Clinical outcomes following surgical management of insertional Achilles tendinopathy using a double-row suture bridge technique with mean two-year follow-up. European Journal of Orthopaedic Surgery & Traumatology 2023;33:1179–1184. doi:10.1007/s00590-022-03270-7

Mr Abbasian sees patients at Guy’s Hospital and in private practice in London. Book a consultation.