Surgery for Insertional Tendinopathy
Surgery for Insertional Tendinopathy is used when conservative management has failed.
Surgery may involve:
- Removal of the bump – this can be done via keyhole surgery or as an open procedure.
- Debridement of the tendon – this may require a larger operation where the tendon is temporarily detached in order to completely remove the damaged tissue before reattaching it back to the heel.
- Gastrocnemius recession (calf lengthening).
The more involved procedures require a prolonged recovery to protect the tendon while it heals back to the bone. During your consultation Mr Goldbloom will discuss which option is best for you and its potential complications.
Post-Operative Care
- When you go home it is very important to elevate the foot 23 hours a day above the level of your heart for two weeks.
- A Physiotherapist will provide you instructions regarding exercises at home.
- You will have a wound review 2-3 weeks after surgery with Mr Goldbloom and a Wound Nurse Specialist. Your dressings are to stay dry and intact until this appointment.
- Patients usually wear a plaster slab for the first two weeks before being placed into a specialised CAM boot designed for Achilles tendon injuries at this first post-operative visit.
- Non-weight bearing is required for 4 to 6 weeks from the time of surgery. You will then be required to walk in the boot for another 6 weeks.
- You will have further appointments with Mr Goldbloom 6 weeks and 3 months after your surgery to assess your recovery.
Refer to the Foot and Ankle Surgery information sheet for further post-operative instructions.
Rehabilitation Following Surgery For Insertional Tendinopathy With Debridement Including Reattachment of Tendon
A physio should lead you through your rehabilitation program after surgery. This table is a guide and changes may be required depending on your progress.
| Week | Exercises | Footwear | Weight bearing | Other |
|---|---|---|---|---|
| 0-2 | Foot intrinsic strength work, STW plantar foot, kinetic chain strength (hip/knee w/o WB op-site). | Plaster Cast | Non-weight bearing | Foot elevated above heart for 23 hours/day |
| 2-4 | PROM | CAM BOOT with 30mm heel lift or VACOPED (3) with wedge | Non-weight bearing | Post surgical consultation at East Melbourne<br /> SItting duties can commence at about 3 weeks after surgery |
| 4-6 | CAM BOOT with 10-20mm heel lift or VACOPED (2-1) with wedge | 50% weight bearing | ||
| 6-8 | Achilles strength program | CAM BOOT with 0-10mm heel lift or VACOPED (1) wedge moving towards (0) no wedge | Full Weight bearing | Weight bearing duties in a boot at about 6-8 weeks<br /> Patient to see Mr Goldbloom at choice of location |
| 8-10** | Achilles strength program | Transitioning to regular footwear from weeks 8-12 | Full Weight bearing | Patient can return to driving automatic car short distances (1 hour) |
| 10-12* | Achilles strength program | Regular Footwear | Full Weight bearing | Patient can return to unrestricted driving |
| 12+ | Strength program and sustained weighted stretch into Ankle DF | Regular Footwear | Full Weight bearing |
Rehabilitation Following Keyhole Surgery For Insertional Tendinopathy By Removal Of Bump
Our team will walk you through your rehabilitation program after surgery. This table is a guide and changes may be required depending on your progress.
| Week | Exercises | Boot | Weight bearing | Returning to Work. | Other |
|---|---|---|---|---|---|
| 0-2 | AROM (all directions), foot intrinsic strength work, STW calf and plantar foot, kinestic chain strength (hip/knee w/o WB op-site), isometric calf strength (straight and bent knee). | Yes | WBAT | Heel lift 30-40mm | |
| 2-4 | Start Achilles strength program | Yes | WBAT | Sitting duties can commence at about 2 weeks after surgery Weight bearing duties in a boot at about 2-4 weeks | Heel lift 20-30mm |
| 4-6** | Achilles strength program | no | FWB | Weight bearing in regular foot wear – 4-6 weeks | Runners – heel to toe drop 10+mm Patient can return to driving automatic car short distances (1 hour) |
| 6-8* | Achilles strength program | no | FWB | As above | |
| 8-10 | Achilles strength program | No | FWB | Any footwear Patient can return to unrestricted driving | |
| 10-12 | Achilles strength program | No | FWB | Any footwear | |
| 12+ | Strength program and sustained weighted stretch into Ankle DF | No | FWB | Any footwear |
Achilles Strengthening Program
| Week | Type of contraction | Exercise | Dosage | Marker for progression |
|---|---|---|---|---|
| 6-10 | Isometric (in neutral) and slow contraction against band | – DL PF | – 5 x 30-60” hold<br /> – 3 x daily each | VAS score 1/10 or less 24 hours after completion on 2 consecutive days |
| 8-12 | Slow eccentric | – SL CR to plantargrade<br /> – Bent knee DL seated CR (conc/ecc) | – 3x10, 5” reps<br /> – 3x15, 2-2-2 rep pace<br /> Performed every 2nd day<br /> Continue iso’s a/a | VAS score 1/10 or less 48 hours after completing for 4-6 consecutive days |
| 12-14 | Heavy slow concentric eccentric | Weighted CR off floor and DL seated CR | – 3 x 6 reps maximum weight possible, 3 x p/week | Progress weight on each exercise for next session when able to complete 3 x 6 and VAS <3/10 for following 48 hours. |
| 14-16 | Closed chain plyometric | – Cont. strength program a/a<br /> – DL CR ‘bouncing’<br /> – Explosive SL CRs | Bouncing: 5 sets 30 reps, twice per week.<br /> Explosive CRs: 3 sets 15 reps, 1-1-1 rep pace. | VAS <3/10 for following 48 hours. |
| 16-18 | Open chain plyometric | – DL CR pogo<br /> – Box jumps, hopping, landing practice | Two session p/week as guided by PT | VAS <3/10 for following 48 hours or PT clinical impression. |
| 18+ | Graduated return to training | Return to running, low load predictable non-contact sports specific drills | 2-3 sessions p/week<br /> Continue plyo’s and strength work on 2-3 other days p/week | PT guidance |
*VAS pain score max 4/10.
^limit ankle DF ROM for insertional tendinopathy with debridement.
+limit ankle PF ROM for mid-portion tendinopathy.
These programs have been developed by Mr Goldbloom in conjunction with Physiotherapists, Brodie Leonard-Shannon and Brendan Mason from Back in Motion, Aspendale Gardens.
Disclaimer: These tables are a guide only to base rehabilitation. Your Physiotherapist has a very important role in monitoring rehabilitation in case changes to fit your personal progress are required.
The information provided here is for general educational purposes only. Please contact Mr Goldbloom's rooms to discuss if surgery is appropriate for your situation.
