70: Surg Post Calcaneal Heel - Feilmeier Flashcards
inflammation of bursa b/w achilles and calcaneus
retrocalcaneal bursitis
hallmark pain anterior to achilles and superior to calcaneal tuberosity (when squeezing side to side in area of bursa, not direct palpation)
retrocalcaneal bursitis
common in runners/athletes (overuse injury, inclines)
s/s retrocalcaneal bursitis
- Pain with compression anterior to achilles tendon just proximal to insertion
- “Two finger squeeze test”
- Edema and/or Erythema in the bursal region
- Pain with activity
- Burning
- Be sure to compare to the non-affected foot
why use heel lift in retrocalcaeal bursitis tx?
- moves heel out of shoe
- reduces pull on achilles
- tilts the proximal calcaneus away from the bursa and provides more room
enlarged posterior/ posterior-lateral aspect of the calcaneal tuberosity-bursal process
(haglund’s deformity)/ pump bump
- May involve the entire posterior aspect
- Different than IACT
- No osteophytes (could be present concomitantly with different etiology/pathology)
- M ay present with retrocalcaneal bursitis
s/s pump bump
- Usually irritation from shoe gear
- usually more lower down on body of calcaneus
- Skin irritation/breakdown
- High heel shoes?
- Women ~16-35
- Can be present at any time, male or female
PE pump bump
- May have erythema and/or edema but not very common
- Pain from shearing
- May have pain on palpation
- Sometimes only painful with/after shoe wear
- Hyperkeratosis
read radiograph
IACT(insertional achilles calcification tendinosis) with concomitant Haglunds
pain most likely due to IACT not haglunds
haglund’s radiographic angle
- (1) Fowler And Philip Angle > 75° (65°)
- (2) calcaneal inclination
- (3)Total Angle > 90° - Ruch
- Parallel Pitch Lines - Pavlov (pictured below) nothing should project above
pain directly on posterior calcaneus conservative tx
silicone sleeve
keck and kelly calcaneal osteotomy
dorsal closing wedge
(+) does not violate the achilles tendon
Chronic degeneration of the Achilles Tendon with thickening/hypertrophy at the insertion or just proximal to it
insertional achilles tendinosis/tendinopathy
- this may present prior to calcification or rupture
why achilles tendinosis NOT tendinitis?
actually degenerative changes due to mechanical problem NOT an inflammatory problem
( so anti-inflammatories not really helpful - only good for pain)
s/s achilles tendinosis/opathy
- Thickening of the tendon/widening of the calcaneus
- Edema and or erythema
- Pain greatest first thing in am/after sitting
- Pain with increased activity/running
surgical treatment achilles tendinosis
- if equinus (usually yes) –> gastroc recession
- also can try stimulation with scalpel, ultarasonic cutting, dry needling
surgery for IACT/ retrocalcaneal exostosis
- Incision
- Multiple variations: Medial, Lateral, Midline, Curve, L
- Careful soft tissue handling
- Straight down, do not open layer by layer
- Split Achilles Tendon longitudinally or remove it from calcaneus (transverse)
- Resection of exostosis
- Saw, osteotomy and mallet
- Remove bursa?
- Debride thickened tendon?
- Address other pathology?
- Equinus
- Reattach Tendon
- Anchors (screw with suture to tie achilles back down)
- Absorbable/non-absorbable
- Suture like
- One or two
