Achilles Tendon Suture bridge
What is Achilles Tendonitis?
Achilles tendonitis presents in patients with repetitive use stressors, or trauma, put on the Achilles tendon. Repetitive stress leads to inflammation which leads to eventual buildup of cartilaginous tissue and eventually bony formation. Symptoms include pain in the back of the heel, direct pressure such as wearing shoes causing pain, and a progressive bony growth on the heel bone. There will be a thickening of the Achilles tendon and midline tenderness at the base of the tendon. Do not confuse the Achilles tendon with the peroneal tendon.
Treatment of Achilles Tendonitis
The first line of treatment of Achilles Tendonitis indicates activity modification, shoe modification, and physical therapy. The patient must reduce stressors that lead to inflammation of the tendon and focus on properly supporting the ankle. Physicians avoid using steroids to reduce inflammation for Achilles tendinosis due to increased risk of tendon rupture. Therapy will focus on strengthening the gastrocnemius while lengthening the muscle and gastrocnemius-soleus stretching. If therapy and lifestyle modification fail, then the patient and surgeon will discuss surgical options. One of the surgical options includes a procedure called the Achilles tendon suture bridge. Do not confuse with a posterior tibial tendon repair.
WHAT IS THE ACHILLES tendon SUTURE BRIDGE
The Achilles Suture Bridge specifically repairs Chronic Achilles calcific tendonitis. Inflammation of the Achilles tendon commonly effects many athletes. Usually resolving in 4-6 weeks. However, recurrent over use or injury can cause chronic inflammation to develop a condition known as Achilles tendonitis. If this persists chronic changes within the tendon develop causing, thickness and swelling of the tendon, which can cause secondary changes forming calcium deposits in the tendon or on the heel bone, weakness, pain and even rupture. Surgery is required to correct these changes if conservative treatment fails. A open surgical procedure, the Achilles tendon suture bridge, to remove bone at the heel (pump bump) and inflamed and degenerated tendon. Consideration of the Achilles tendon suture includes over 50% of the tendon being removed, or patient obesity. The surgeon debrides the Achilles tendon, removes bony growth from the ankle bone, and reattaches the tendon with bone anchors and sutures. Additional anchors below the tendon insertion serve as additional attachment points for the sutures holding the tendon in place.
Recovery from a Achilles Tendon Suture Bridge
A boot with a raised heel insert and crutches will be used for two weeks post op. Weight bearing should be minimal and should be avoided if uncomfortable. The patient may remove the heel raise after two weeks and stop using crutches with physician approval. The boot will still need to be worn outside of therapy sessions. After a month consideration of short bouts of walking without a boot may be considered if comfortable. After six weeks the boot will begin to be phased out as comfort allows. At 10 weeks the patient should bear full weight without a boot. Benchmarks will continue in therapy until -about 4 months in and most patients fully recover by month 4 to 6.
