Surgical treatment of insertional Achilles tendinosis.

Most patients with insertional Achilles tendinosis can be managed nonoperatively but those who do not respond may require excision of the diseased tendon. Currently, there are no clinical studies indicating how much of the tendon may be excised without predisposing the patient to Achilles tendon rupture. This chart review reports on 52 heels treated surgically for this condition and followed for a minimum of six months postoperatively. When less than 50% of the tendon was excised (49 heels) patients were immediately mobilized free of a cast. There were two failures using this regimen--one patient with psoriatic arthropathy and another who underwent bilateral simultaneous procedures. We suggest that in selected patients it is safe to proceed with early active mobilization immediately postoperatively when less than 50% of the tendon is resected.