70: Surg Post Calcaneal Heel - Feilmeier Flashcards

1
Q

inflammation of bursa b/w achilles and calcaneus

A

retrocalcaneal bursitis

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2
Q

hallmark pain anterior to achilles and superior to calcaneal tuberosity (when squeezing side to side in area of bursa, not direct palpation)

A

retrocalcaneal bursitis

common in runners/athletes (overuse injury, inclines)

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3
Q

s/s retrocalcaneal bursitis

A
  • ›Pain with compression anterior to achilles tendon just proximal to insertion
    • ›“Two finger squeeze test”
  • ›Edema and/or Erythema in the bursal region
  • ›Pain with activity
  • ›Burning
  • Be sure to compare to the non-affected foot
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4
Q

why use heel lift in retrocalcaeal bursitis tx?

A
  • moves heel out of shoe
  • reduces pull on achilles
  • tilts the proximal calcaneus away from the bursa and provides more room
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5
Q

enlarged posterior/ posterior-lateral aspect of the calcaneal tuberosity-bursal process

A

(haglund’s deformity)/ pump bump

  • ›May involve the entire posterior aspect
  • ›Different than IACT
  • ›No osteophytes (could be present concomitantly with different etiology/pathology)
  • ›M ay present with retrocalcaneal bursitis
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6
Q

s/s pump bump

A
  • ›Usually irritation from shoe gear
  • usually more lower down on body of calcaneus
  • ›Skin irritation/breakdown
    • ›High heel shoes?
  • Women ~16-35
    • ›Can be present at any time, male or female
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7
Q

PE pump bump

A
  • ›May have erythema and/or edema but not very common
  • ›Pain from shearing
  • ›May have pain on palpation
  • ›Sometimes only painful with/after shoe wear
  • ›Hyperkeratosis
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8
Q

read radiograph

A

IACT(insertional achilles calcification tendinosis) with concomitant Haglunds

pain most likely due to IACT not haglunds

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9
Q

haglund’s radiographic angle

A
  • ›(1) Fowler And Philip Angle > 75° (65°)
  • (2) calcaneal inclination
  • ›(3)Total Angle > 90° - Ruch
  • ›Parallel Pitch Lines - Pavlov (pictured below) nothing should project above
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10
Q

pain directly on posterior calcaneus conservative tx

A

silicone sleeve

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11
Q

keck and kelly calcaneal osteotomy

A

dorsal closing wedge

(+) does not violate the achilles tendon

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12
Q

Chronic degeneration of the Achilles Tendon with thickening/hypertrophy at the insertion or just proximal to it

A

insertional achilles tendinosis/tendinopathy

  • this may present prior to calcification or rupture
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13
Q

why achilles tendinosis NOT tendinitis?

A

actually degenerative changes due to mechanical problem NOT an inflammatory problem

( so anti-inflammatories not really helpful - only good for pain)

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14
Q

s/s achilles tendinosis/opathy

A
  • ›Thickening of the tendon/widening of the calcaneus
  • ›Edema and or erythema
  • ›Pain greatest first thing in am/after sitting
  • ›Pain with increased activity/running
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15
Q

surgical treatment achilles tendinosis

A
  • if equinus (usually yes) –> gastroc recession
  • also can try stimulation with scalpel, ultarasonic cutting, dry needling
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16
Q

exostosis w/ or w/o spurring at achilles tendon insertion

A

retrocalcaneal exostosis

17
Q

s/s retrocalcaneal exostosis or IACT

A
  • ›Dull aching pain, tenderness at insertion
  • ›Sharp/burning
  • ›Achilles Tendon thickening
  • ›Pain with ROM and palpation
  • ›Equinus
18
Q

surgery for IACT/ retrocalcaneal exostosis

A
  • ›Incision
    • ›Multiple variations: Medial, Lateral, Midline, Curve, L
    • ›Careful soft tissue handling
    • ›Straight down, do not open layer by layer
  • ›Split Achilles Tendon longitudinally or remove it from calcaneus (transverse)
  • ›Resection of exostosis
    • ›Saw, osteotomy and mallet
  • ›Remove bursa?
  • ›Debride thickened tendon?
  • ›Address other pathology?
    • ›Equinus
  • ›Reattach Tendon
    • ›Anchors (screw with suture to tie achilles back down)
    • ›Absorbable/non-absorbable
    • ›Suture like
    • ›One or two
19
Q

main complication achilles tendon surgery

A

wound dehiscence (good disection is key)

also issue with painful scar (like a new bump)