HEEL SPUR WITH INSERTIONAL ACHILLES TENDINITIS
You have been diagnosed with a common problem associated with a chronic over pull of the Achilles tendon as it inserts into the back of the heel. A bone spur often forms, and a weak point or stress riser develops. In light of the fact that the Achilles tendon is the largest tendon in the body and has one of the poorest blood supplies, patients are predisposed to fracture or insertional pain termed enthesopathy as a result of the demand. Once this becomes a chronic problem your options become limited. You may be placed into a below-knee cast or fracture walking boot for a period of 6-8 weeks to improve or resolve symptoms. Unfortunately, once a patient has been removed from the cast or walking boot, the symptoms often return, and most patients eventually progress to surgical correction.
Surgical removal of the posterior heel spur and partial detachment and reattachment of the Achilles tendon requires approximately three months of primary healing. Secondary healing will take place for 1-2 years. In the initial phase, the surgical procedure consists of partial detachment of the Achilles tendon and removal of the spur formation. The tendon is then reattached to the heel bone by use of a soft tissue bone anchor where the tendon is tied directly to the bone. Due to the relatively poor blood supply of the Achilles tendon and its significant mechanical responsibility, it is necessary to protect the surgical site for approximately three months.
Your doctor may choose to perform an additional procedure, termed a gastrocnemius recession, in conjunction with the one previously discussed. This procedure is performed through an incision above the heel and is utilized to gain length of the Achilles tendon. As stated above, the cause of the bone spur in the posterior region of the heel is a result of an extreme tightness within the Achilles tendon. Often times, patients may be able to stretch this tendon prior to surgery, thus eliminating the need for the procedure. If the procedure is mandated, the recovery time is the same as for the initial procedure above.
After the initial surgery, you will typically be sent home in a splint, which is half a cast that allows for postoperative swelling. This is removed at two weeks along with the sutures, and a full-length below-knee fiberglass cast is then applied, which is typically lighter. For the first four weeks, you are required to utilize crutches for ambulation. After four weeks, you may gradually start to bear weight on the cast to tolerance with the assistance of crutches or a walker. If there is pain in the region, it is best for you to continue non-weight-bearing with the crutches.
After eight weeks from surgery or six weeks from the application of the fiberglass cast, the cast is removed, and x-rays are taken. If proper healing is noted on the x rays, you will be allowed to ambulate with a fracture walker, very often supplemented with a soft cast on the surgical area. After two weeks, the soft cast is removed, and you may simply ambulate with the fracture walker for another two weeks. You will also be required to procure an elastic sleeve that will fit around your foot and ankle to be worn for approximately 3-6 months after surgery to help control postoperative swelling.
At approximately 12 weeks, or three months from the time of surgery, the fracture walker is then discontinued, and you may begin utilizing walking boots or high-top tennis shoes with a heel lift. Gradual exercise or a rehabilitation program is implemented at this stage and over the next 4-8 weeks, including muscle strengthening and calf rebuilding. At six months from the time of surgery, a return back to normal activities is permitted; however, it should be noted that this is a gradual ongoing process that may take another six months.
At approximately one year from the time of surgery, you are allowed unrestricted normal activity to tolerance. Please realize there are many factors that affect the healing process, including age, vascular status, weight, and lifestyle requirements. These all must be factored into the equation when determining return to work and athletic activities. The outcome of this type of surgery is usually very rewarding, and most patients are able to return to their previous level of lifestyle without any significant compromise or alteration.
As always, we, the physicians and staff of Beaumont Foot Specialists, are here to assist you in your postoperative convalescence with any questions or concerns you may have. We appreciate you choosing us for your foot health care provider and trust that your surgery and convalescence go as planned.