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Achilles Debridement surgery

Posted by Tbone on 2/28/05 at 07:38 (170119)

While preparing for a marathon, I developed pain in the back of both heels, but it was definitely worse on the left side. The pain was a burning sensation that would stay with me for a couple of days AFTER running, not during the run. Achilles tendinosis was the diagnosis. After going through every type of conservative treatment available (including casting) I had achilles debridement surgery on my left foot last May. This involved a repair and graft of the partially torn tendon, a bone excision of the Haglunds deformity, and he also removed some bone spurs from the back of the heel. He also did a nerve release procedure at the same time. I still had a lot of pain when I started to run again a few months after surgery, so I backed off. Began a conservative walking/running program in late November. I am now up to running two miles, but believe it or not, I am still experiencing the same burning sensation and tenderness in the back of my heels! There was one bone spur he couldn't remove because it was directly under the insertion point of the achilles.

I guess my question is why did the surgery not seem to make that much difference? Did my doctor or myself miss something here? Or am I just not giving all of this enough time yet?

Any help would be so much appreciated. I've been dealing with this for over two years now.

Re: Achilles Debridement surgery

Dr. Z on 2/28/05 at 13:45 (170151)

Hi
It the pain is where the Achilles Tendon inserts into the back of the heel and you are post eight months surgery then ESWT could be a treatment that could help you. Are you familiar with ESWT ?

Re: Achilles Debridement surgery

ShelleyFitz on 2/28/05 at 14:00 (170152)

Hi

No I am not famaliar with that. Will it break up scar tissue because I have alot where the surgery incisions are. Every time I had surgery the Dr. would snap my toes down to break it up but it keeps coming back. There was some talk about clipping my achilles tendon to stretch it as the back of my legs are extremely tight. Would ESWT help to take some of the pain away from my toes and instep as well as me heels???
Please advise.

Thank you,

Shelley Fitz

Re: Achilles Debridement surgery

Dr. Z on 2/28/05 at 14:14 (170153)

If you have what is called equinus, decrease range of motion or lack of bending at the ankle joint then lengthing the achilles tendon or moving the insertion would be the correct treatment. If you have plenty of motion and the pain is at the insertion then ESWT is a very effective treatment.

Re: Achilles Debridement surgery

Tbone on 2/28/05 at 15:29 (170158)

I think someone hijacked my topic, but anyway...Yes, the pain is right at the insertion point on the heel. I was told that there was a prominent bone spur underneath the tendon that couldn't be removed because that would require detaching the tendon. Could ESWT break down the bone spur? I'm just moderately aware of ESWT, but would like to learn more. I live in the Atlanta area.

Re: Achilles Debridement surgery

Dr. Z on 2/28/05 at 16:03 (170160)

Hi

If the tendon isn't short and the pain is at the insertion ( tendinosis) and you have pain when you first get up in the morning or after sitting for any lenght of time then ESWT could help you. Go to our web site http://www.eswtusa.com or e-mail Dr. Z , (email removed) if you would like additional information about this topic. I have used ESWT for Achilles tendinosis for over five years with very effective pain resolution.

Re: Achilles Debridement surgery

Mike C on 2/28/05 at 17:34 (170170)

Shelly,
ESWT is not FDA approved for Achilles tendidnitis, so your insurance is not going to pay for it, nor does it treat the cause of the problem. Insertional tendinitis responds very well to phonophoresis. A technic perfomed by a therapist consisting of application of a topical steroid compound and ultrasounding over it.
The issue, in your case, is more then likely tight calf muscles as you have said. 1) I would not consider lengthening your Achilles. This is not a prudent idea in a young active indiviual. 2) If there is a difference in your ability to dorsiflex your ankle with your knee straight and flexed (defined as a contracture of your gastrocnemius) then an isolated release of the gastrocnemius tendon would relieve the tension causing the irritation at the insertion while not compromising your power output. 3) If, in fact, you have a painful 'spur' within the insertion of your Achilles this can be removed by detaching the Achilles, removing the spur and reattaching the Achilles.

Both of these procedures have been performed in college athletes who have returned to a competitive level.

Re: Achilles Debridement surgery

Dr. Z on 2/28/05 at 18:10 (170173)

Mike C
I agree if the cause is due to a tight calf muscles then this must be addressed. A tendinosis is a degenerative condition and therefore typically won't respond to any type of physical therapy, although it is worth the try . Ionophoresis can be effective if the condition is a tendonitis and not a tendinosis.
ESWT isn't FDA approved for achilles tendinosis however I can tell you from experience is it very effective for insertional achilles tendinosis., without equinus.
There is one clarification none of the treatments in your post are FDA approved. One is very invasive ( detachment of achilles tendon) and has the possibility of leaving the patient with a limp for the rest of their life.

Re: Achilles Debridement surgery

Mike C on 2/28/05 at 20:02 (170183)

Dr. Z, the surgical procedures I outlined are commonly performed by skilled surgeons and provide good outcomes. The surgical procedures address the cause. In the case of ionto or phonophoresis, these reduce the -itis associated with the -osis and hence the discomfort. I don't know of any patients that are limping after surgery. In addition, the alternatives I posted are covered by insurance. I realize shock-wave therapy has been successful for vaious problems, however, as I pointed some time ago there are no long term statistically significant studies supporting it use. Further, not having FDA approval can be very expensive. I view this modality as a conservative last resort.

Re: Achilles Debridement surgery

Fed Up Also..... on 3/02/05 at 08:38 (170264)

Oh yeah, ESWT, the cure all, treatment of choice (for the Dr. wallets), success rate of ??% but the placebo had a better recovery rate (check the FDA and AMA for results). Good luck and if I was you I'd do a little research before investing in ESWT.

Extra
Sums of cash
Will buy a new
Truck

Extort
Stupid people with
Wizardy and
Tricks

Re: Achilles Debridement surgery

Mike C on 3/02/05 at 18:27 (170324)

Dr. Z, the surgical procedures I outlined are commonly performed by skilled surgeons and provide good outcomes. The surgical procedures address the cause. In the case of ionto or phonophoresis, these reduce the -itis associated with the -osis and hence the discomfort. I don't know of any patients that are limping after surgery. In addition, the alternatives I posted are covered by insurance. I realize shock-wave therapy has been successful for vaious problems, however, as I pointed some time ago there are no long term statistically significant studies supporting it use. Further, not having FDA approval can be very expensive. I view this modality as a conservative last resort.

Re: Achilles Debridement surgery

MrO on 3/03/05 at 09:52 (170348)

Actually, my insurance DID completely cover ESWT. The procedure was MUCH more painful than I was made to believe. I had been told that I could run the very next day, as long as I didn't increase my level of activity. The next day, my ankle was black and blue and it was all I could do to drag my foot as I walked.

In a couple of weeks the pain of the procedure was gone, and the pain seemed completely gone. Unfortunately, six months later the pain is back to the original levels after running.

My original MRI showed bone fragments in the bursa, I'm wondering how much of the pain in this heel is from the damaged bursa. Then again, the ESWT doesn't claim to address root cause, which is the bone spurs of the Haglund's cutting into the bursa and achilles tendon.

Re: Achilles Debridement surgery

Dr. Z on 3/07/05 at 23:33 (170671)

Mike C

I do agree that we must address the cause and that in cases where there is an Achilles equinus and or gast equinus you must address these issues.
Where is there is an achilles tendinosis ESWT is a very effective treatment and as we both know any type of surgical treatment whether debridment or AT lengthening or Gastronemius release can have potential complications. I do agree that a skilled surgeon will have good outcomes as well as some very poor disabling outcomes which have nothing to do with the skill but with the procedure. I am just offer an alternative that has shown effective results with long term pain resolutions regardless of insurance coverage.

Re: Achilles Debridement surgery

Mike C on 3/09/05 at 08:13 (170780)

Dr. Z - I believe in treating the cause of the problem. Usually a mechanical one. I have yet to have a disabling results - just lucky, I guess?

Re: Achilles Debridement surgery

JulieS on 10/07/09 at 21:27 (261144)

I read your comments, your procedure sounds identical to the one I am scheduled for next week, he is talking about taking off the tendon and cleaning up the spur behind it, reattaching the tendon, My doctor told me it would be a good 6-months before it would be better, I spoke to a gal that had it and she said it took her a year. I just want to know does it feel better now?

Julie