43: Insertional Achilles Tendonitis - Smith

Question 1

insertional achilles tendinitis aka

Answer 1

posterior/retro calcaneal pain

Question 2

etiology of haglund’s deformity ***

Answer 2

• Cavus Foot
• Compensated Rearfoot Varus
• Forefoot Valgus
• Plantarflexed First Ray
• Overuse/poor training
• Systemic diseases
• Shape of calcaneus
• Equinus

Question 3

bump directly at insertion of achilles tendon

Answer 3

retrocalcaneal bursitis/exostosis

Question 4

bursa between achilles tendon and calcaneus

Answer 4

retrocalcaneal bursa

could have an abnormal bursa form on the posterior surface of calcaneus too

Question 5

s/s haglund’s deformity

Answer 5

Dull ache
Aggravated by shoe gear
High heel shoes?
Women 20-30

Question 6

PE haglund’s deformity ***

Answer 6

Erythema
Edema
Pain on palpation
Pump bump
Hyperkeratosis

Question 7

radiographic angles associated with haglund’s deformity ***

Answer 7

Fowler And Philip Angle 75° (65°)
- increased with deformity

Total Angle 90° - Ruch
- combines fowler and philip with calcaneal inclination

Parallel Pitch Lines - Pavlov

• line on inferior calcaneus and line on superior calcaneus
• bone above the second pitch line is a haglund’s deformity

Question 8

normal calcaneal inclinantion angle

Answer 8

25 degrees
flatfoot smaller
cavus foot higher

Question 9

treatment haglund’s deformity ***

Answer 9

Heel Lift
Open Shoe
Orthotics 
NSAID’S
Ice
Physical Therapy
Injections?
Surgery

Question 10

surgical incisions for haglund’s deformity

Answer 10

• Fowler and Philip
• Lateral Linear * most commonly used
• Lateral Lazy L
• Two Incisional

Question 11

where is haglund’s deformity?

Answer 11

posterolateral aspect of calcaneus

Question 12

“chasing the bump”

Answer 12

• resect more bone than planned because trying to smooth the surface off
• compromises the achilles tendon insertion

Question 13

post op management for haglund’s deformity surgery

Answer 13

• Short Leg Cast 4 Weeks
• Unna Boot With Heel Lift 10 Days
• Physical Therapy

Question 14

describe a retrocalcaneal exostosis

Answer 14

• Exostosis with or without spurring at Achilles Tendon insertion
• May see calcification of tendon, bursitis, tendinitis or Haglund’s deformity

Question 15

types of calcification of achilles tendon

Answer 15

Type I:
continuous with calcaneal insertion (microtrauma, biomechanical
related, SNA)

Type II:
insertion zone, separated from the os calcis (ACC, pseudogout)

Type III:
proximal to insertion zone (trauma, post-surgical, Wilson disease, ischemia)

Question 16

s/s retrocalcaneal exostosis

Answer 16

• Etiology similar to Haglund’s deformity
• Dull aching pain, tenderness AT INSERTION
• Achilles Tendon thickening
• Pain with ROM and palpation
• Equinus

Question 17

surgical tx retrocalcaneal exostosis

Answer 17

• Resection of exostosis
• Splitting Achilles Tendon or removing it from calcaneus
• long recovery time
• Keck and Kelly
• Wedge osteotomy in body to relocate the posterior insertion to a more anterior and superior position (can also be used for Haglund’s)
• doesn’t compromise the achilles tendon insertion

Question 18

potential complications of surgery

Answer 18

• Achilles Tendon rupture
• Scar
• Nerve entrapment
• Equinus
• Wound dehiscence
• Fracture
• Recurrence