Quick answer
Insertional Achilles surgery can be more complex than simply removing a painful lump. Depending on the pathology, it may involve debridement of diseased tendon, removal of calcification or posterosuperior calcaneal prominence, treatment of bursitis and secure tendon reattachment.
Article
The tendon-bone interface
Because the pathology is at the insertion, adequate exposure and debridement may require partial detachment of the Achilles. If so, the tendon must be securely repaired back to bone.
Bone and tendon are considered together
A symptomatic prominence or calcification may be addressed when it is clinically relevant, but bone should not be removed merely because it appears on an X-ray.
More extensive disease
If a large proportion of the insertion is severely diseased, reconstruction or tendon augmentation may be considered. The decision depends on tissue quality, age, activity, comorbidities and operative findings.
Key points
- Insertional surgery has particular wound-healing considerations because of the posterior heel soft-tissue envelope.
- The amount of tendon detached affects fixation and rehabilitation.
- Not every Haglund prominence needs removal.
Frequently Asked Questions
Will the Achilles be detached from the heel?
Sometimes partially, depending on the amount and location of diseased tissue that must be treated.
Are anchors always required?
No. Fixation depends on the procedure and how much tendon requires reattachment.