Achilles Tendon Pathology
The Achilles tendon is the main plantar flexor of the ankle. Patients can also develop a non-insertional tendonitis, insertional calcific tendinopathy, retrocalcaneal bursitis, or rupture of the tendon. Insertional Achilles tendonitis is pain and tendon thickening at the Achilles insertion into the calcaneus. This is usually treated conservatively but can require debridement, reinsertion of the tendon, and sometimes tendon transfer. Retrocalcaneal bursitis is an inflammation between the bursa anterior to the Achilles and the posterior aspect of the calcaneus. A Haglund deformity of the calcaneus is often present. This is usually treated conservatively but can require debridement, reinsertion of the tendon, and sometimes tendon transfer. Rupture of the Achilles tendon is most common in men ages 30–40 years of age and can occur during sudden forced plantarflexion or dorsiflexion in a plantar flexed foot. The rupture usually occurs 4–6 cm above the calcaneal insertion in the hypovascular area of the tendon. Treatment can be nonoperative in functional bracing/casting in equinus or operative with repair and sometimes either a VY advancement and/or FHL transfer.