Insertional Achilles Tendinopathy: Surgical Options

Insertional Achilles tendinopathy is a chronic condition in which patients describe functional impairment, pain, and swelling at the tendon insertion. Treatment is primarily nonsurgical with physical therapy, nonsteroidal anti-inflammatory drugs, rest, heel lifts, or heel sleeves; but for patients who fail nonsurgical management, surgical debridement of the Achilles tendon at its insertion can provide relief. The goal of surgery is to remove the diseased tendon and intratendinous calcifications, as well as to address associated pathology, including inflamed retrocalcaneal bursa, prominence of the posterior-superior calcaneal tuberosity, and gastrocnemius contracture. This article presents the author's preferred technique for surgical treatment of insertional Achilles tendinopathy and discusses the rationale behind this technique. (C) 2008 Elsevier Inc. All rights reserved.