Calcaneoplasty for Insertional Tendinopathy of Achilles Tendon

Painful thickening of the soft tissues at the Achilles tendon insertion – the so-called pump pump

• Prominent swelling of the heel

• Pain on palpation typically over the center of the Achilles tendon insertion

• Pain can be provoked or enhanced by tiptoeing

Painful soft tissue swelling and tenderness along both sides of calcaneal tuberosity

May be associated with

• Local skin lesion

• Misalignment of hindfoot

Plain radiographs

• Standard anteroposterior (AP) and lateral views of the foot, an AP view of the ankle, and an axial view of the calcaneus should be obtained to assess overall osteoarticular structures and deformities.

• On a lateral weight-bearing view, Haglund calcaneal deformity may be present as a marked osseous prominence of the tuber calcanei with swelling of soft tissues.

• Heel spurs and intratendinous ossification processes can also be detected on lateral view ( Fig. 71.1 ).

  

Magnetic resonance imaging (MRI)

• MRI findings may include significantly increased signal intensity and thickening at the insertion area of the Achilles tendon.

• MRI also allows for the assessment of pathologic processes and disorders of the Achilles tendon, e.g., degenerative disease, partial ruptures, and cyst formation ( ; Fig. 71.2 ).

  

Sonography

• Sonography may be helpful to detect pathologic changes at the distal Achilles tendon and chronic retrocalcaneal and subcutaneous bursitis ( ; Fig. 71.3 ).