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Scientific News in Foot Pain (Part 2):
Non-Insertional Achilles Tendinopathy Treated with Gastrocnemius Lengthening
Tendinitis of the Achilles tendon is one of the most frequent problems that I see. It can be located either directly above the back of the heel or behind the ankle. When it is behind the ankle, it is often a bulbous lump. Sometimes people are concerned that it may be cancer, but tumors in this area are very rare. When it is near the heel (insertional Achilles tendinitis), it can rub on the counter of the shoe.
Prolonged nonoperative treatment including physical therapy, immobilization, weight relief, and strengthening exercises for two months or more are generally recommended prior to any consideration of surgery. Surgical treatment involves removing the scarred and degenerated tendon and repairing it. The recuperation can be painful and prolonged. The success rate is generally quoted at between 70 and 90%.
Dr. Duthon and her associates (Duthon VB et al. Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening. Foot Ankle Int. 2011 Apr;32(4):375-9) have reviewed the success of gastrocnemius tendon lengthening in treatment of non-insertional Achilles tendinitis after two years. This surgery involves cutting a portion of the tendon/muscle area in the midcalf. Lengthening of the tendon in this area is easier to recover from and is usually less painful. It relieves some of the tension around the inflamed area. Of the 14 patients (three whom had both of the tendons done in this manner), all but one was satisfied with the results, and 11 of the 14 were able to resume their previous sporting activities. MRIs taken of the area showed a decrease in the signal hyper intensity, suggesting that some healing had occurred.
I find this study interesting not only because it demonstrates a easier, more effective, less direct surgical treatment for Achilles tendinitis, but also because it seems to suggest that loosening the gastrocnemius muscle complex aids in the healing of Achilles tendinitis. Because of this, I am more convinced that stretching exercises along with eccentric muscle/tendon conditioning directed at loosening the gastrocnemius muscle nonoperatively can be effective if treatment is continued over a long period of time.
–Brett Fink, MD. Co-author of The Whole Foot Book: A Comprehensive Guide to Taking Care of your Feet
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