Posterior Calcaneal Spur - Diseases of the Achilles Tendon - CENTRE FOR ORTHOPAEDICS, SPORTS MEDICINE AND REHABILITATION - Dr. Erich H. Rembeck

Posterior Calcaneal Spur

Posterior Calcaneal Spur/ Insertions Tendinopathy / Bursitis – General points

A special form of chronic achilles tendon pain is the posterior calcaneal spur, often referred to as Haglund exostosis. In this case there is an enlargement of the posterior calcaneum, which results in a fraying of the achilles tendon on the calcaneum. As a consequence, in less serious cases only an inflammation of the protective tendon bursa arrises. If this condition can be interrupted at an early stage by sufficient relief and physical measures, an inconsequential healing of the disease can occur.

By advancement of the disease initial thickening of the bursa occurs, leading later to a bonding between the achilles tendon and calcaneum. The disease usually remains due to the fact that through the continuous friction, and through the swelling-induced friction-increase between the bursa and calcaneum, an expansion of the calcaneum is triggered which further worsens the process.

In the final stage, there is a rough connection between the bone and the free portion of the achilles tendon, which makes a pain-free weight-bearing impossible. At this stage a non-surgical therapy is no longer promising.

Surgical Therapy

If the pain in the region of the bony achilles tendon tip leads to a necessity for surgical treatment, a combined procedure is performed consisting of the removal of scarred, modified and bonded tendon parts in the region of the tip of the calcaneum, the removal of the inflamed bursa, as well as the reduction of the internal excess pressure-triggering calcaneum.

In individual cases of pronounced changes of the achilles tendon in the region of the crossover of the calcaneum, the detachment of the tendon can be required, so that the re-insertion of the tendon must occur with a screw anchor in the bone. As long as no complete detachment of the tendon had to be undertaken, aftercare occurs in a light drop-foot lower leg cast (approx. 15 °) for up to 2 weeks and subsequent weight-bearing in the O ° lower leg orthosis (Vacuped schoe) with 20 kg of of partial weight-bearing for approximately 4 weeks.

The recommencement of the ability to undertake competitions can be strived for at approx. 12 weeks after the operation. If an anchoring of the tendon in the bone with the use of a suture anchor occurred, the aftercare treatment will be undertaken in the same way as that for a complete tear of the achilles tendon