Insertional 

Achilles tendinopathy /Tendonitis

 

Pain, swelling or a bony prominence at the back of the heel may be caused by insertional Achilles tendinopathy, affecting the point where the Achilles tendon attaches to the heel bone.

The Pain of Heel spurs can be chronic and unremitting.  Often know as a ‘pump bump’ or tendonitis with spur this heel pain can be miserable.

 

Can Insertional Achilles Tendinopathy Be Treated Without Surgery?

Often the surgery is avoided by treating conservatively such as.

• Insoles
• Physio
• Shoewear  adjustments
• Lifestyle changes including Weightloss.
• Ankle Braces

For a broader explanation of Achilles pain, why it develops and the non-operative treatment options, read my guide to Achilles tendonitis and Achilles tendinopathy.

The surgery (Speedbridge Technique)  is used though when the tendon has actually become calcified at the insertion and there is a physical hard lump.  Once formed it won’t disappear without surgery.

Your surgeon may discuss with you about combining the procedure with a stabilising ligament reconstruction of your ankle if the brace has significant impact in your conservative treatment.

What Does the surgery for Achilles reattachment involve?

Achilles Insertional Tendinopathy / Enthesopathy

Achilles Speedbridge is an implant by ‘Arthrex’ &  technique I use to treat the pain and physical prominence of chronic Insertional Achilles tendonopathy.  There is often a heel spur as seen in the above picture.

See Video at bottom for animated guide

‘Speedbridge’  allows the damaged part of the tendon to be debrided of the calcified and damaged tissue.  The hard lump associated can be sawn away and then the tendon is reattached using the system in the video.

It is done as a daycase procedure under anaesthetic.

What is the recovery from Achilles Reattachment (Speedbridge) like?

Recovery involves being in a 1/2 cast (Backslab) for 2 weeks followed by a boot with wedges under the heel for 4-6 weeks usually. Then begins your serious work of gradual rehabilitation and strengthening to performance levels that can take 6 months or more and should be done with a great and focussed physio team. 

What are the risks of Achilles Surgery?

There are naturally risks associated with the procedure that you would need to consider and should always be discussed with your surgeon.  Specific to this operation they include.

• • Wound concerns – The skin in this area doesn’t have a brilliant blood supply and on occasions especially if you get an infection can breakdown. This can require specialist further treatment and can can make for a poor outcome.  Its is of particular concern in people who smoke cigarettes (possibly vape too).  The wound is also over the back of the heel and occasionally it can remain sore even longer time just from contact rubbing in shoes.

• • Infection.  Mild infection in the wound edge is not too uncommon and if recognised usually settles with tablet antibiotics.  If however the repair, implants or bone gets infected it can be serious and need prolonged treatment, even further surgery. Often the presentation of infection is unexpected pain or fluid seen at wound or in a dressing and should mean you get in touch with your surgeon.

• • Thrombosis / DVT/Blood clot in the leg. This is a serious condition felt as a calf cramp or swelling that doesn’t go away.  If suspected you would go for scans and blood tests. I use a preventative regime around the surgery and initial recovery that involves a flight sock on the other leg and blood thinning injections you self administer (Enoxaparin).  Even so it can still happen.
  • Rupture / pull-off of the repair.  Sticking to the post op plan is vital to help prevent this complication whereby the repair / reattachment fails and effectively the achilles becomes ruptured.  If it happens further rehab and quite possibly surgery can be needed. Key things you can do include sticking to the plan of careful wedge removal as instructed and only ,ovens the ankle as instructed ‘If it doesn’t hurt’ to do so.
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