• 1. 

    Clain MR & Baxter DE: Achilles tendinitis. Foot Ankle 13 : 482, 1992.

  • 2. 

    Waldecker U , Hofmann G & Drewitz S: Epidemic investigation of 1394 feet: coincidence of hindfoot malalignment and Achilles tendon disorders. Foot Ankle Surg 18 : 118, 2012.

    • Search Google Scholar
    • Export Citation
  • 3. 

    Kvist M: Achilles tendon injuries in athletes. Ann Chir Gynaecol 28 : 472, 1991.

  • 4. 

    Hunt KJ , Cohen BE & Davis WH et al.: Surgical treatment of insertional Achilles tendinopathy with or without flexor halluces longus tendon tendon transfer: a prospective, randomized study. Foot Ankle Int 36 : 998, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5. 

    McLauchlan GJ & Handoll HH: Interventions for treating acute and chronic Achilles tendinitis. Cochrane Database Syst Rev 2 : CD000232, 2001.

    • Search Google Scholar
    • Export Citation
  • 6. 

    Kearney R & Costa ML: Insertional Achilles tendinopathy management: a systematic review. Foot Ankle Int 31 : 689, 2010.

  • 7. 

    Greenhagen RM , Shinabarger AB & Pearson KT et al.: Intermediate and long-term outcomes of the suture bridge technique for the management of insertional Achilles tendinopathy. Foot Ankle Spec 6 : 185, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8. 

    Maffulli N , Del Buono A & Testa V et al.: Safety and outcome of surgical debridement of insertional Achilles tendinopathy using a transverse (Cincinnati) incision. J Bone Joint Surg Br 93 : 1503, 2011.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9. 

    Vulpiani MC , Guzzini M & Ferretti A: Operative treatment of chronic Achilles tendinopathy. Int Orthop 27 : 307, 2003.

  • 10. 

    Yodlowski ML , Scheller AD & Minos L: Surgical treatment of Achilles tendinitis by decompression of the retrocalcaneal bursa and the superior calcaneal tuberosity. Am J Sports Med 30 : 318, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11. 

    McGarvey WC , Palumbo RC & Baxter DE et al.: Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach. Foot Ankle Int 23 : 19, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12. 

    Watson AD , Anderson RB & Davis WH: Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional Achilles tendinosis with calcific spur. Foot Ankle Int 21 : 638, 2000.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13. 

    Ahn JH , Ahn CY & Byun CH et al.: Operative treatment of Haglund syndrome with central Achilles tendon-splitting approach. J Foot Ankle Surg 54 : 1053, 2015.

  • 14. 

    Lin HA , Chong KW & Yeo W: Calcaneoplasty and reattachment of the Achilles tendon for insertional tendinopathy. J Orthop Surg 22 : 56, 2014.

  • 15. 

    Nunley JA , Ruskin G & Horst F: Long-term clinical outcomes following the central incision technique for insertional Achilles tendinopathy. Foot Ankle Int 32 : 850, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16. 

    Johnson KW , Salavras C & Thordarson DB: Surgical management of insertional calcific Achilles tendinosis with a central tendon splitting approach. Foot Ankle Int 27 : 245, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17. 

    Maffulli N , Testa V & Capasso G et al.: Calcific insertional Achilles tendinopathy: reattachment with bone anchors. Am J Sports Med 32 : 174, 2004.

  • 18. 

    Wagner E , Gould JS & Kneidel M et al.: Technique and results of Achilles tendon detachment and reconstruction for insertional Achilles tendinosis. Foot Ankle Int 27 : 677, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19. 

    Rousseau R , Gerometta A & Fogerty S et al.: Results of surgical treatment of calcaneus insertional tendinopathy in middle- and long-distance runners. Knee Surg Sports Traumatol Arthrosc 23 : 2494, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20. 

    Rigby RB , Cottom JM & Vora A: Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients. J Foot Ankle Surg 52 : 575, 2013.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21. 

    Elias I , Raikin SM & Besser MP et al.: Outcomes of chronic insertional Achilles tendinosis using FHL autograft through single incision. Foot Ankle Int 30 : 197, 2009.

  • 22. 

    DenHartog BD: Use of proximal flexor hallucis longus transfer in severe calcific Achilles' tendinosis. Tech Foot Ankle Surg 1 : 145, 2002.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23. 

    Nawoczenski DA , Barske H & Tome J et al.: Isolated gastrocnemius recession for Achilles tendinopathy: strength and functional outcomes. J Bone Joint Surg Am 97 : 99, 2015.

  • 24. 

    Tallerico VK , Greenhagen RM & Lowery C: Isolated gastrocnemius recession for treatment of insertional Achilles tendinopathy: a pilot study. Foot Ankle Spec 8 : 260, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25. 

    Miyamoto W , Takao M & Matsushita T: Reconstructive surgery using autologous bone-patellar tendon graft for insertional Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 20 : 1863, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26. 

    Kolodziej P , Glisson RR & Nunley JA: Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund's deformity: a biomechanical study. Foot Ankle Int 20 : 433, 1999.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27. 

    Taylor GI & Palmer JH: The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40 : 113, 1987.

  • 28. 

    Attinger CE , Evans KK & Bulan E et al.: Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg 117 : 261, 2006.

    • Crossref
    • Search Google Scholar
    • Export Citation

Surgical Treatment of Insertional Achilles Tendinopathy: A Systematic Review

Ruth Moen
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Jacob R. Hagenbucher
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Andrew B. Shinabarger
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Background

Insertional Achilles tendinopathy is a common complaint among patients. Oftentimes, conservative treatment is inadequate, and surgical treatment is required. However, there is no published consensus regarding surgical intervention in reference to insertional Achilles tendinopathy.

Methods

The purpose of this systematic review was to evaluate the surgical management of insertional Achilles tendinopathy and report which surgical procedures provide the greatest pain reduction and improvement in functional outcome. A review of PubMed, OVID, Google Scholar, and Cochrane Controlled Trials Register was performed using a defined search strategy and inclusion criteria.

Results

Of 2,863 articles identified using the defined strategy, 20 met the inclusion criteria (three prospective and 17 retrospective). Operative interventions included Achilles tendon debridement, reattachment with suture anchors, reconstruction with flexor hallucis longus tendon autograft or bone-patellar tendon autograft, and gastrocnemius recession. All of the studies, regardless of intervention, showed generalized improvement after surgery. Wide variation in outcome scoring systems prevented direct comparison between studies and interventions.

Conclusions

This systematic review did not identify a superior treatment for insertional Achilles tendinopathy but rather found that the surgical treatment should be based on the extent of tendon injury.

Legacy Health/Kaiser Permanente Foundation, Portland, OR.

Corresponding author: Ruth Moen, DPM, Legacy Health/Kaiser Permanente Foundation, 1015 NW 22nd Ave, Northrup Bldg, Ste 22, Portland, OR 97210. (E-mail: RMoen@LHS.org)