achilles tendon and heel

by Pat
(Dickinson, ND, USA)

My left foot was injured in snowmobile accident. I could not walk on it for several weeks. My doctor said it was pulled muscle. After not getting better I went to specialist. Did MRI and xrays. Inner tendon and Achilles tendon had lots of swelling and had tear in calf muscle. Put me in boot and started therapy. After 2 months therapy, was not improving. Did xray again and found a sharp piece of bone had broke off off my heel and was poking into my Achilles tendon. Suggested surgery, but said they would have to cut tendon from my heel to get to bone. This would be extensive healing time and therapy again. Also said probably would have only 70% of foot usage again. We decided to give it time and see if it would improve. 4 months later no improvement. Walk with limp and can not wear shoes that push on back of my foot. I dont understand why they can not remove such a small piece of bone lapriscopically (not spelled write). Doctor said could not do it. He has done lots of Achilles surgeries. Any suggestions would really help.

RESPONSE

Hi Pat,

There are many orthopedic procedures that can be done through minimal incision surgery, but this sounds like it is not one of them. I have no x-rays to look at but based on your narrative and where you are having pain, it sounds to me like the piece of broken bone is adjacent to the Achilles tendon.

In these instances, the Achilles tendon has to be dissected away from the bone in order to reach the piece of broken bone.

Failure to remove the Achilles tendon could result in one of two problems. The first would be that all of the broken piece of bone might not be removed which would then continue to give you pain, so that does not sound like a viable option.

The second potential problem is that if the Achilles ends up being partially torn and is not properly repaired you run the risk of the tendon snapping on you and then you end up back at square one.

If you are going to bother to do this, then you want to do it one time only. The tendon would have to be dissected away, the broken piece of bone removed and then the detached tendon would have to be re-attached properly. This gives you the best chance of healing without further issues.

Yes, you will have to be none weight-bearing for a period of time and may require physical therapy but once this is all over you are finished.

I am not sure about the 70 percent use of the tendon afterwards. If the procedure is properly planned out with the possibility that the tendon would also have to lengthened a bit, then I would think your use of the foot and ankle would be greater than 70 percent. Of course, I know nothing about you in terms of your size, your age, your athleticism, etc. so it is difficult for me to really predict the outcome of your surgery.

Keep in mind, even if you wear backless shoes the rest of your life, you will still have a piece of irregular bone pressing into the Achilles tendon and over time the tendon will weaken and could then rupture.

We have all seen the movie where someone is rock climbing and part of the rope is rubbing up and down over the edge of the rock and the rope finally tears. This is what could happen to your tendon constantly rubbing against a sharp piece of bone.

It sounds like you may not have much of choice here, but the best piece of advice I could give you would be to go get a second opinion by a local doctor. If the second doctor agrees with the first then it should make your decision much easier.

Marc Mitnick DPM
DISCLAIMER