Return to Sport and Physical Activity After Calcaneoplasty for Insertional Achilles Tendinosis

Hong, Sean Lai Wei; Ying, Camelia Tang Qian; Thwin, Lynn; Thevendran, Gowreeson

doi:10.1053/j.jfas.2016.07.012

Cited by 11 publications

(8 citation statements)

References 45 publications

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“…For patients with intra-tendinous bone pathology and failed conservative treatments, major surgery is often instituted. 19 Tendon detachment-bone removal-tendon re-attachment, 2 3 or bone removal via longitudinal tenotomy, 6 followed by initial immobilisation and long rehabilitation periods, 20 is commonly used. The results vary, and the need for a long low-loading rehabilitation period is not optimal for any patient.…”

Section: Discussionmentioning

confidence: 99%

“…Despite promising results in several studies, 6 7 19 the rehabilitation period is long and includes an initial period with immobilisation. 20 Traditionally, these surgical methods do not specifically focus on removal of the subcutaneous bursa. Recent research on innervation patterns has shown the subcutaneous bursa to be the most richly innervated tissue in patients with severe pathology in the Achilles tendon insertion.…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

Alfredson

Spang

2020

BMJ Open Sport Exerc Med

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BackgroundInsertional Achilles tendinopathy is well known to be difficult to treat, especially when there is intra-tendinous bone pathology. This study is a case series on patients with chronic insertional Achilles tendon pain and major intra-tendinous bony pathology together with bursa and tendon pathology, treated with excision of the subcutaneous bursa alone.MethodsEleven patients (eight men and three women) with a mean age of 44 years (range 24–62) and a chronic (>6 months) painful condition from altogether 15 Achilles tendon insertions were included. In all patients, ultrasound examination showed intra-tendinous bone pathology together with pathology in the tendon and subcutaneous bursa, and all were surgically treated with an open excision of the whole subcutaneous bursa alone. This was followed by full weight-bearing walking in a shoe with open heel for 6 weeks.ResultsAt follow-up 21 (median, range 12–108) months after surgery, 9/11 patients (12/15 tendons) were satisfied with the result of the operation and 10/11 (13/15 tendons) were back in their previous sport and recreational activities. The median VISA-A score had improved from 41 (range 0–52) to 91 (range 33–100) (p<0.01).ConclusionIn patients with chronic painful insertional Achilles tendinopathy with intra-tendinous bone pathology, tendon and bursa pathology, open removal of the subcutaneous bursa alone can relieve the pain and allow for Achilles tendon loading activities. The results in this case series highlight the need for more studies on the pain mechanisms in insertional Achilles tendinopathy and the need for randomised studies to strengthen the conclusions.Level of evidenceIV Case series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

Alfredson

Spang

2020

BMJ Open Sport Exerc Med

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“…Function was assessed by nine measurement instruments from 4% (11/307) of all studies (Table 2; Fig. 2) [15,24,76,122,136,142,187,224,275,290,294]. The Ankle Activity Score was reported most frequently (n = 3) [24,142,187].…”

Section: Functionmentioning

confidence: 99%

“…2) [15,24,76,122,136,142,187,224,275,290,294]. The Ankle Activity Score was reported most frequently (n = 3) [24,142,187].…”

Section: Functionmentioning

confidence: 99%

“…Quality of life was assessed by five questionnaires from 8% (24/307) of all studies (Table 2; Fig. 2) [3,16,17,32,47,54,80,95,107,118,121,131,142,146,159,182,197,200,208,228,240,244,299,300]. SF-36 was the most frequently reported (ten studies) [32,47,54,107,118,131,142,146,200,244] followed by EQ-5D (nine studies) [16,17,80,95,182,197,240,299,300].…”

Section: Quality Of Lifementioning

confidence: 99%

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ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy

et al. 2021

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Background Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. Objective To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. Design Systematic review. Data Sources Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. Eligibility Criteria for Selecting Studies Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. Results 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. Conclusion 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. Prospero Registration CRD42020156763.

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Tendinopathien an Fuß und Sprunggelenk

Gaulke

Krettek

2017

Unfallchirurg

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Tendinopathies of the foot and ankle result in substantial impairment of the mobility of patients and have a high clinical significance. Knowledge of the origin of these diseases has been accumulated over decades from the multitude of intrinsic and extrinsic triggering factors based on biomechanical considerations with an evidence-based medicine (EBM) level 5. A high correlation between tendinopathy and hypervascularization of the Achilles tendon was found in a double-blind randomized prospective study using Doppler ultrasound (EBM level 1) but these results were not reproducible; therefore, the importance of these findings is unclear. Inspection and clinical examination supplemented by ultrasound and magnetic resonance imaging (MRI) are essential to achieve the correct diagnosis. The varying extent of load-dependent irritation of tendons and the surrounding tissues and the individual variation in experience of investigators mean that the results of clinical examinations are difficult to collate or not reproducible and cannot be investigated in studies. The expression of the varying results is difficult to assess even by the use of sonography and magnetic resonance imaging (MRI). Conservative treatment of tendinopathy is based on medical experience (EBM level 5). The effectiveness of physiotherapeutic eccentric loading and extracorporal shock wave treatment (ESWT) for Achilles tendinopathy was demonstrated in several case control studies and series (EBM level 3). Due to the high rate of healing with physiotherapy, surgery should only be performed following a minimum of 6-12 weeks of unsuccessful conservative treatment, because formation of scar tissue on the foot can result in permanent complaints (EBM level 4).

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Return to Sport and Physical Activity After Calcaneoplasty for Insertional Achilles Tendinosis

Cited by 11 publications

References 45 publications

Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone—a case series

ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy

Tendinopathien an Fuß und Sprunggelenk

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