XXIVe Journée scientifique de l’AMISEK du samedi 10 décembre 2005
CONTROVERSES EN CHIRURGIE ET REEDUCATION DE LA CHEVILLE

Chairmans : Dr M. Jeanjot et M. Y. Xhardez - Président d’honneur : Dr M. Clemens

Auditoire de l’Institut Supérieur d’Ergothérapie et de Kinésithérapie (Haute Ecole P.-H. Spaak)

 

TENDOPATHY OF THE ACHILLES TENDON

 

STEINBOCK Gunther, MD

(former) Chief of department for foot surgery at the

Orthopedic Hospital Speising in Vienna, Austria

 

 

In pathology of the Achilles tendon the followinjg entities are distinguished: affections of the tendon sheeths presenting as acute or chronic paratenonitis (peritendinitis) and of the tendon itself (tendopathy, tendinosis, tendinitis). Insertional tendopathy occurs at the tuber cacanei, non insertional at about four to five centimeters proximal to it. This is an area of reduced blood supply to the tendon.

Pathology is usually due to overuse of the tendon in relation to its capacity of endurance. Histologically in paratenonitis signs of inflammation are found while in tendopathy necrosis is prevalent. The degenerative alterations in the tendon can finally lead to its rupture.

Surgery is performed if conservative therapy fails. In paratenonitis two thirds of the posterior circumference of the tissue are removed, the anterior third is left intact to preserve the blood supply to the tendon.

With tendinosis the tendon is combed by longitudinal incisions and removal of necrotic areas. Recently longitudinal incisions of the Achilles tendon from several stab wounds of the skin were found to be useful. The idea is to promote revascularisation and strengthening by scar formation. If more than fifty percent of the substance of the tendon has to be removed some kind of augmentation must be applied. Turn down flaps or tendons of the area, usually the flexor hallucis longus tendon can be used for that. If, in case of rupture, primary suture seems inadequate or impossible, the above mentioned procedure and/or lengthening of the tendon by v-y-plasty or pencil case plasty (a healthy part of the midportion of the tendon is mobilized and pulled down) will provide for a reliable repair.

Insertional tendinosis is frequently accompanied by calcaneal bursitis. The usual procedure there will be removal of the postero-superior edge of the tuber calcanei together with the bursa and support by transfer of the flexor hallucis longus tendon.