New procedures and techniques speed Achilles tendon recovery

Many Achilles tendon surgery patients are getting back on their feet faster, thanks to new procedures and techniques.

The introduction of tissue graft products, bone anchors, radio frequency treatments and new arthroscopic procedures provides patients with less invasive treatments and speedier recovery times. More than 1,000 foot and ankle surgeons are learning about the latest treatments and techniques for foot and ankle conditions at the American College of Foot and Ankle Surgeons (ACFAS) 66th Annual Scientific Conference in Long Beach this week.

"Whether it's getting back to work faster, or getting back to marathon training, these surgical advances will shorten recovery times for many types of patients," says Des Moines, Iowa foot and ankle surgeon Michael S. Lee, DPM, FACFAS. Lee serves on the ACFAS board of directors.

The Achilles tendon connects the calf muscle to the heel bone in the back of the leg and facilitates walking. The most common Achilles condition is tendonitis, an inflammation of the tendon. Most tendonitis cases can be successfully treated with non-surgical methods such as rest, ice, anti-inflammatory medications and physical therapy.

But some tendonitis patients develop scar tissue on the tendon, or their tendon fibers weaken and develop microscopic tears, a condition called Achilles tendonosis. Fixing these problems can require invasive surgery and weeks to months of recovery.

Recently-introduced radio frequency technology can slash recovery time for some patients by using radio waves to stimulate healing in the tendon. The procedure requires smaller incisions to insert the wand-like radio frequency device. Smaller incisions mean less damage to skin and muscle, less pain, and lower risk of surgical infections. Patients recover faster.

Overuse, especially in athletes, can cause the Achilles tendon to tighten and pull so hard on the heel bone that a bone spur, or bump, develops. Shoes can rub against the spur and cause pain. In addition, a painful fluid-filled sac called a bursa can develop between the heel bone and the tendon. Traditionally, correcting this tightness involved severing the tendon, removing the bone spur or bursa, and then reattaching the tendon.

New arthroscopic techniques can provide a minimally invasive option to removing bone spurs and bursas without significant damage to the Achilles tendon. When the tendon does have to be surgically detached, new bone anchor constructs (screws that are drilled into the heel bone to secure the tendon and tissues) can reattach the tendon, minimizing the chance of a potentially painful knot on the back of the heel.

Achilles tendon ruptures are the most serious Achilles injuries. Most patients require surgery to decrease the likelihood of a re-rupture. Various techniques are available, and increasingly may include tissue grafts used as a bridge to link the severed tendon lengths. The graft provides a scaffold on which new tissue grows, increases the overall strength of the repair, and is usually absorbed by the body within a year.

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