Surgical Management of Insertional Achilles Tendinopathy
Summary
Insertional Achilles tendinopathy is characterised by pain, degeneration and often calcification at the point where the Achilles tendon attaches to the calcaneus. When conservative measures fail, surgical intervention aims to excise bony prominences and calcific deposits, debride degenerate tendon tissue and restore robust tendon-bone healing. Established open techniques include longitudinal or central tendon-splitting approaches for direct exposure, excision of retrocalcaneal bursae, debridement of diseased tendon and ostectomy or calcaneoplasty of the posterosuperior calcaneal prominence. Endoscopic calcaneoplasty offers reduced soft-tissue trauma but requires precise bone resection. In cases with increased tendon tension, dorsal closing wedge osteotomy of the calcaneus can elevate the insertional footprint and redistribute load. Repair strategies frequently employ suture anchors, with double-row refixation providing enhanced contact area and pull-out strength. Across techniques, outcomes are measured by improvements in pain scores (VAS), function (AOFAS, FAOS, VISA-A) and patient satisfaction, with most series reporting substantial relief and early mobilisation. Ongoing refinements seek to minimise wound complications, optimise bone resection volumes and tailor osteotomy planning to individual anatomy, reflecting the global need for durable solutions in both athletic and ageing populations.
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Surgical Management of Insertional Achilles Tendinopathy publication trend
The graph below shows the total number of articles in surgical management of insertional achilles tendinopathy across all publications each year (not limited to Nature Index journals).
Technical terms
Insertional Achilles tendinopathy: Degenerative condition affecting the Achilles tendon at its calcaneal insertion, often with intratendinous calcification and retrocalcaneal bursitis.
Debridement: Surgical removal of diseased or calcified tendon fibres and inflamed bursal tissue to restore healthy tendon structure.
Osteotomy: Surgical cutting of bone (for example, the calcaneus) to realign anatomy or offload tendon insertion.
Double-row refixation: Tendon repair method using two parallel rows of suture anchors to increase fixation strength and tendon-bone contact area.
References
- Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome. Journal of Orthopaedic Surgery and Research (2020).
- The Double‐Row Suture Technique: A Better Option for the Treatment of Haglund Syndrome. BioMed Research International (2016).
- Central Tendon‐Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy. BioMed Research International (2019).
- Open versus endoscopic bone resection of the dorsolateral calcaneal edge: a cadaveric analysis comparing three dimensional CT scans. Journal of Foot and Ankle Research (2014).
- Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation. Foot & Ankle International (2021).
- Calcaneal osteotomy due to insertional calcaneal tendinopathy: preoperative planning. Journal of Orthopaedic Surgery and Research (2022).
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