Surgical treatment of Achilles tendinitis by decompression of the retrocalcaneal bursa and the superior calcaneal tuberosity.

BACKGROUND

Initial nonoperative treatment of pain at the Achilles tendon, often referred to as "tendinitis," is not always successful.

HYPOTHESIS: Surgical treatment is effective for patients with insertional tendinitis unrelieved by nonoperative measures.

STUDY

DESIGN

Retrospective cohort study.

METHODS

Thirty-five patients (41 feet) who had painful Achilles tendon syndrome unrelieved by 6 months of nonoperative measures were treated surgically. The technique consisted of a single incision along the lateral border of the Achilles tendon. The dissection exposed the retrocalcaneal bursa and fat pad, which were completely excised along with any scarred and thickened paratenon. A partial calcaneal exostectomy of the tubercle was performed.

RESULTS

At a minimum follow-up of 20 months (average, 39), the patients' pain scores (rated from 0 to 6) improved from 4.7 (SD, 1.1) preoperatively to 1.5 (SD, 1.3); 90% had complete or significant relief of symptoms, 10% felt improved, and none felt unchanged or worse.

CONCLUSIONS

Surgical treatment of chronic Achilles tendon pain with resection of the prominent tuberosity, complete debridement of the bursa, excision of thickened, scarred paratenon, and removal of accessible calcific deposits within the tendon is an effective treatment.