ENDOSCOPIC CALCANEOPLASTY FOR “CALANEO-ACHILLES IMPINGEMENT”
By Robert H. Sheinberg, D.P.M., F.A.C.F.A.S., D.A.B.F..A.S.
What is it?
- Endoscopic (with a miniature camera and small incisions) surgical removal of a bony prominence in the back of the heel.
Causes of this bony prominence and pain:
- Enlarged bone called the calcaneus that presses on the front portion of the Achilles tendon.
- Usually seen in high arched feet.
- Associated with “Haglund deformity” or “pump bump”.
- Injury of heel bone or a fracture causing displacement of the top of the heel bone backwards. This causes irritation of the bone against the Achilles tendon.
- Chronic bursitis (retrocalcaneal) caused by friction between the Achilles tendon and the heel bone.
- Associated with a foot type called a rearfoot varus in which the heel bone has a slight curvature inward.
Signs and symptoms:
- Painful enlarged bump on the back of the heel bone.
- Swelling is often present and associated with a bursitis.
- Always tender to touch the bony prominence.
- Often associated with an overlying callus or hard skin over the area.
- Pain is often present in closed shoes as the heel bone presses against the back of the shoe.
- Pain is often present while moving the foot up (dorsiflexion).
Advantages of an endoscopic surgical procedure:
- Minimally invasive surgery with two incisions approximately 1/6” in length.
- Decreased risk of complications including infection and nerve injury.
- Quick return to shoes.
- Faster return to sports and activities.
- Does not weaken the Achilles tendon postoperatively.
- Decreased postoperative pain.
Imaging used for diagnosis:
- Often see an enlarged bone in the back of the heel.
- A loss of the soft tissue plane on x-rays indicative of bursitis and swelling.
- A high inclination of the heel bone.
- May see calcification of the Achilles tendon which may or may not be associated with the pain or problem.
- Often used to visualize the retrocalcaneal bursa in thickening of the Achilles tendon.
- Used dynamically to see the impingement of the Achilles tendon against the heel bone.
- Used to identify bone marrow edema that is present in the area of the impingement of the tendon against the heel bone.
- Used to identify any associated Achilles tendon damage that may be present.
- Used to visualize the retrocalcaneal bursa and any associated soft tissue pathology.
- Used to visualize any associated bone deformity that may be present.
- Local anesthesia may be injected directly into the bursa between the tendon bones. Relief of pain for a few hours will help distinguish this condition from other associated problems and give us an indication of the benefits of cervical decompression by an “Endoscopic Calcaneoplasty”.
- A thorough history and physical examination is performed.
- Evaluation of any bone or soft tissue abnormality is identified.
- Gait analysis to identify any abnormality that may cause the impingement or aggravate the problem line.
- X-rays, MRIs and ultrasounds are often performed to help complete the examination.
- Open surgical procedures can be performed to decompress the area.
- “Endoscopic calcaneoplasty to remove the bony prominence and decompress the Achilles tendon from pressuring the heel bone.
How is it performed:
- Outpatient surgical procedure under a local, twilight or general anesthetic. This is usually the patient’s choice as to the type of anesthesia that they desire to use.
- Two small incisions approximately 1/6” in length are made on each side of the Achilles tendon.
- Specialized instruments including a small camera and surgical burs are used to visualize and remove the bony prominence of the heel bone against the Achilles tendon. If the Achilles tendon has some damage, this can be cleaned up as well.
- One stitch is used to close each incision.
- Surgical boot for 3 to 28 days may be necessary depending on the amount of bone that is resected.
- Early range of motion begins the next day after surgery to prevent adhesions.
- Physical therapy may be started in three days to restore range of motion and strength and to decrease swelling.
- Swimming may be performed in seven days.
- Running may begin on the treadmill in 7 to 28 days.
- Most sports can be resumed in 2 to 6 weeks.
- Excellent in almost all cases with minimal risk.
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