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Foot orthopedics is a sphere of medicine that specialized on musculoskeletal problems related to the foot. Orthopedics doctors deal with different types of disorders including muscles and bones diseases, nerves damage and vascular problems in cooperation with other specialists. Modern German orthopedics clinics provide multidisciplinary services on foot orthopedics offering complex diagnostics, conservative treatment and surgery if needed.
Our feet are under constant load throughout life. It is not surprising that 75% of us, especially women, have this or that problem with our feet in different periods of life.
Many factors affect the health of our feet ‒ the level of activity, occupation, the condition of other bones and joints, and perhaps most importantly, footwear. Most of the problems that arise in the foot are attributed to footwear, so it is very important to choose footwear that is good for your feet. The foot is an incredibly complex mechanism.
Among the tremendously wide range of foot and ankle problems the most common are:
- Foot and Ankle Arthritis
- Bunion disorder (deformation of big toe joint)
- Achilles Tendinitis (Achilles tendon enlargement)
- Heel pain
- Claw toe
- Hammer toe
Foot orthopedics operations can be divided depending on problems treated, methods applied and part of the foot. Based on problem the foot surgery can be divided as following:
- Hammer toe correction
- Surgery for Morton’s neuroma
- Ankle replacement
Fusion is the type of surgery when two bones of the joint are fused in one. It is applied to restore severe destroyed bones though the joint becomes less flexible. The two bones are held together with stabilizing plates or screws and over time they are grown together as a result of activation of natural processes. Sometimes donor bone from the other areas can be used for better coupling that is called bone graft.
Depending on area undergone to operation fusion can be split as following:
- Ankle fusion (surgery of ankle joint)
- Hindfoot fusion (heel and surrounding)
- Midfoot fusion (middle part of the foot)
- Forefoot (toes)
Bunions are bony bumps that develop at the junction of the big toe and the foot. They can form for a long time while the big toe gradually bend to the next toe and, finally, lean over it. When advanced, the condition might be painful and cause difficulties while walking and, then, it requires surgery. During this rather simple procedure surgeon will remove the bumps. Operation may or may not include joint alignment which is considered by orthopedic surgeon.
Hammer Toe and Claw Toe Surgery
Hammer toe is a condition when the toe become permanently bent and claw. The problem can be improved with arthroplasty or arthrodesis (fusion) depending on stage and patient’s preferences.
Ankle replacement is a procedure to replace degenerative ankle joint with artificial implant. Newest types of implants provided better result than it was before and gives reliable and long lasting result.
Most of the foot orthopedics operation can be performed both with traditional open operation and advanced minimally invasive technique.
Minimally invasive arthroscopic surgery can be used as alternative to open foot surgery in many cases including fusion surgery, ankle replacement, removal of loose cartilage, repairing torn ligaments, fixing foot fractures and others. Arthroscopy is also often used as a tool for diagnostics for determining joint, muscles and vessels problems. Comprehensive approach applied in German clinics allows treating complex problems in one surgery.
There are many kind of arthritis but rheumatoid arthritis is more common for the foot. In simple words, arthritis is inflammation of synovium (a lining that covers your joints). Rheumatoid arthritis can affects bones, joints, muscles and nerves and results in degenerative changes in the foot. The symptoms of disorder are swelling, pain and stiffness and, when severe, they can significantly influence the quality of your life. Further development can cause most of above mentioned diseases as a result of joints and bones deformities, e.g. claw toes, bunions and others. Modern orthopedics suggests many solutions to people with chronicle and acute problems.
Among conservative treatments the orthopedists suggest:
Change of moving activities and rest. Patient is advised to stop activities harming the foot and relax not giving much load to the affected foot.
Oral medication. Nonsteroidal anti-inflammatory drugs are common option for rheumatoid disease.
Injections. Cortisone can be used to decrease symptoms of arthritis in earlier stage if disease.
Orthopedics appliances. Some special devices as orthotic or braces and orthopedic shoes can be used for correction a number of problems.
In severe stages your orthopedics doctor may recommend you surgery.
The presence of flat-footedness, the imperfection of foot ligaments, aggravated by wearing uncomfortable narrow fancy shoes with heels, provokes changes in the feet. Unfortunately, such transformations turn out to be not only an aesthetic problem, but also a medical one. The basis of the disease is an increase in the angle between the 1st and 2nd metatarsal bones, as a result of which there is a progressing deformation of the toes, the formation of exostoses, inflammation of the tissues around the joint and associated with it swelling and pain.
A long course of the disease leads to premature wear of the joints of the foot, a significant cosmetic defect, and in the outcome it leads to the patient’s disability. Modern low-impact surgical methods of treatment used in german clinics provide correction of various types of foot deformities, eliminate the deviation of the big toe, reduce pressure on the affected joints, help to achieve good and excellent aesthetic and functional results.
Hallux valgus is a common pathology of the foot, the manifestation of which is the lateral deviation of the big toe.
The disease is not only an aesthetic problem, but also a serious medical one. In addition to the deviation of the big toe, the disease causes many other pathological changes in all parts of the foot.
The etiology of this disease is not fully found out. It is likely that hereditary disorders of connective and bone tissue, leading to flat feet conditions, play a large role in the onset of the disease.
The wrong footwear is also conducive to the progression of the deviation of the toe. Most often these are narrow fancy shoes with high heels. Such shoes lead to an increase in pressure on the forefoot, squeezing the toes forcing them to remain in a faulty position for a long time, after which the deformity and arthrosis in this area is formed.
An important factor in the progression of the disease is a hereditary factor.
To diagnose diseases of the foot, its radiography is performed, which makes it possible to identify the amount of the deformity, as well as the pathology accompanying it.
Radiography in combination with a physical examination performed by an orthopedic traumatologist can detect the causes of the disease, find out how far the disease has progressed and determine what type of surgery can eliminate this type of deformity and free the patient from the accompanying manifestations.
The duration of the operation is about 1.5 hours. It is performed under spinal anesthesia, while the patient is conscious, therefore the risk of developing complications associated with anesthesia is extremely low. The advantage of the surgery is the admissibility of moving with the load on both feet, in special shoes, already in 24 hours after the operation. The result is that it becomes possible to perform the intervention on both feet simultaneously. After the surgery bandaging is performed, and sutures are removed in 12-14 days. During this period of time, oedema and tenderness in the foot area are possible. Patients can return to work, depending on the profession, in 10-14 days.
There are many different surgeries for Hallux valgus. The type of surgery most often depends on the degree of deformity and can be performed both on soft tissues and on bones.
At different times, wires and screws were used for fixation. They remained in the foot forever or were removed some time after the operation. Surgeons in Germany practise a combination of operations on bones and soft tissues, which leads to a more reliable result. They use modern screws of a special form, which provide reliable fixation until complete consolidation of the bones after the operation.
During SCARF osteotomy, surgical access to the metatarsal bone and metatarsal-phalangeal joint is performed. Then exostosectomy is performed. If necessary, the doctor eliminates the muscle imbalance, leading to the progression of deformity. During the operation, a horizontal longer cut and two short transverse sawcuts of the first metatarsal bone are made. Depending on the direction and angle of the osteotomy, there are ample possibilities for the correction of various types of deformities. Then, the reached position is fixed with two screws.
For less severe deformities, Chevron osteotomy can be used. The osteotomy shape resembles the letter V. The operation is performed in the distal row of the metatarsal bone. After correcting the deformity by displacing the bone fragments relative to each other, the new position is also fixed by a special screw.
Akin osteotomy is performed on the proximal phalanx of the first toe. Most often it is performed as an auxiliary operation for osteotomies of the metatarsal bone or operations on soft tissue structures. The essence of the operation is in cutting out a fragment of the phalanx bone of a certain shape and size, depending on the type of the deformity. All these osteotomies, if necessary, are combined with various types of operations on soft tissues.
Metal screws and braces firmly fix the bones to their full union. In this way, it is possible to correct the deformities of the first finger, relieve the patient’s pain while walking, and also restore the beauty and slenderness of their feet.
After the surgery patients, as a rule, wear special shoes for some time, which reduces pressure on the forefoot. Sutures are removed in 12-14 days after the surgery.
Hallux rigidus or stiff big toe is a consequence of the degenerative transformation of the metatarsophalangeal joint of the big toe. Hallux rigidus is the result of a long-term progressive deforming arthrosis in the metatarsophalangeal joint of the big toe, which can be characterized by sharp stiffness, deformation of the big toe, as well as pain while walking. As the disease progresses, the cartilaginous surface of the joint wears out, and distinctive excrescences (osteophytes) form around the joint. The trigger for the progression of arthrosis can be an injury of the joint, permanent overload or any systemic disease. Sometimes the cause of arthrosis cannot be established.
The plusphalangeal joint is the first metatarsal bone and the proximal phalanx of the toe. Like any other joint in the body, it is covered with articular cartilage. The articular cartilage covers the ends of the bones. It is very smooth and shiny and has a whitish color.
If for some reason the joint is injured, the articular cartilage begins to slowly wear out and collapse. The articular cartilage can wear off to the bone. As a result, movements in the joint become painful, and osteophytes start growing on the edges of the joint. Osteophytes around the joint limit the movement in it, the dorsal flexion (flexion upwards) of the toe is affected most of all.
Osteophytes also irritate the adjacent soft tissues, which causes inflammation in these tissues. Clinically, inflammation is characterized by pain and oedema.
The true causes of the disease are still unknown. Many surgeons believe that in most cases, the disease begins with the damage to the articular cartilage, which occurs as a result of, for example, hitting your toe against an obstacle.
The degenerative process in the joint develops over several years before the first symptoms appear.
The disease can occur in young people, but it is more common among those who are over 50 years of age. Arthrosis of the 1st metatarsophalangeal joint is more common among women than among men. A hereditary factor plays a major role in the etiology of this disease. In cases where the disease is inherited among family members, the process is localized on both inferior limbs.
Under certain circumstances, Hallux rigidus develops without any significant injuries. The peculiarities of the foot anatomy and the constant overload of the joint, related to it, can cause its premature destruction. The process of destruction and wear of the joint goes on for many years.
Degenerative changes in the metatarsophalangeal joint cause two problems ‒ pain and loss of mobility. The reduced range of motion in the first metatarsophalangeal joint prevents the forefoot from adequately rolling from heel to toe while walking, making each step difficult and extremely painful. The pain is the sharpest when the toes and the foot lose contact with the ground. The pain is exacerbated by wearing high-heeled shoes.
Bone excrescences or exostoses can put pressure on nearby nerves, causing numbness in the foot. There may be problems with the selection of footwear because of the deformity in the area of the joint.
Conservative treatment includes anti-inflammatory therapy to control pain and oedema. The patient is offered special shoes that facilitate the process of walking. In some cases, cortisone is injected into the joint area, which significantly relieves pain, but, unfortunately, only temporarily.
Surgical treatment can be the method of choice when conservative treatment has failed.
In some cases exostoses or spurs appear around the joint and prevent the toe from bending. These excrescences cause problems while walking, preventing the big toe from pushing off the ground normally while walking.
Cheilectomy is an operation in which bone excrescences around the joint, especially in its upper part, are removed, thereby increasing the range of motion and reducing the pain.
This surgical procedure is supplemented with the osteotomy of the metatarsal bone, the purpose of which is to perform decompression (relieve pressure) of the articular surfaces. The purpose of the surgery is to shorten the first metatarsal bone, which reduces the pressure of the metatarsal bone on the proximal phalanx, thereby also reducing the pain syndrome. When shortening the bone, the surgeon fixes it in the new position with intra bone screws. Such operations are often performed in young patients, when there is a chance to extend the life of the joint.
Many surgeons prefer arthrodesis of the bones that make up the metatarsophalangeal joint. This operation greatly relieves the pain. The purpose of the operation is the fusion of the metatarsal bone and the proximal phalanx in a functionally advantageous position.
The articular surfaces during the operation are excised, placed in a functionally advantageous position and fixed with screws. The big toe after the operation does not move. The pain symptom is significantly reduced after the surgery. Complete fusion of the bones usually ends within three months.
The method of choice in the treatment for osteoarthritis of the first metatarsophalangeal joint is the complete replacement of the joint, similar to knee or hip joint replacement. During this operation, the articular surfaces are removed and replaced with artificial surfaces, often metal.
This operation makes it possible not only to reduce pain, but also to preserve the joint mobility. One of the shortcomings of this operation is probably not very long life span of the endoprosthesis. Over time, the endoprosthesis may get loose and the movement in it is disturbed, which may require reoperation. It should be noted that, according to many scientific studies, patients highly appreciate the functional results of the 1st metatarsophalangeal joint replacement with the endoprosthesis. There are other surgical procedures that can supplement the operations described above. These include various types of osteotomies, as well as plastic surgery on soft tissues.
Sutures after the surgery are usually removed on the 10-14 day. Patients are prescribed a special physiotherapy. They can walk immediately after the operation in special shoes.
A hammer toe is one of the most common deformities of the lesser toes. In most cases, this problem is combined in a patient with valgus deformity of the first finger (hallux valgus), and is also observed in patients with hollow cavovarus deformity and with severe chronic concomitant diseases. However, it is worth noting that most often it is not possible to identify the cause of the hammertoe deformity.
Doctors refer the metatarsal bones and toes to the forefoot. The toes are made up of several bones. The big toe or the first toe consists of two phalanxes. The remaining four toes consist of three phalanxes (proximal, middle and nail). In the metatarsophalangeal joints the toes unite with the metatarsal bones. There are also joints between the toe phalanxes.
The proximal interphalangeal joint is between the proximal and middle phalanxes. The distal interphalangeal joint is formed by the middle and nail phalanxes. Each of the joints is surrounded by an articular capsule, and the bones in the joint are held by the ligaments. The tendon extends along the top or dorsal surface of the toe, which straightenes the toe. There are also two tendons on the plantar or bottom surface, which bend the toe.
In everyday life, patients or doctors of other specialties call all toe deformities hammer toes. However, orthopedic surgeons distinguish several types of toe deformities:
- Hammer toes;
- claw toes;
- mallet toes.
If the degree of hammertoe deformity is large, and the disease has been progressing for a long time, one can observe a contracture of the toe. The patient or the doctor cannot straighten the hammer toe to its initial position. Contracture develops when scar tissue fills the joints of the toe and restricts movement in them. With such fixed deformities and contractures, surgery may be a possible treatment option.
There are a large number of various surgery procedures to treat deformities of small toes. The choice of the operation depends on the type of the deformity, as well as on the patient’s individual characteristics and the presence of concomitant diseases.
In case of hammertoe deformity, correction of the position of the toe is achieved by resection of the interphalangeal joint. During the operation, the painful plantar callus on the toe is also excised. The toe is displayed in its straight position and is fixed with a pin for 4 weeks. If the patient has a combination of the hammertoe deformity of the second finger and the valgus deformity of the first finger, an additional operation is performed to correct hallux valgus.
With transverse platypodia, when the heads of the metatarsal bones are lowered to the sole of the foot, and the subluxation of the toes in the metatarsophalangeal joints is detected, an additional osteotomy of the metatarsal bone is necessary, for example, Weil. Osteotomy is the creation of an artificial fracture in a specific area in order to correct bone deformity.
The goal of Weil osteotomy is to eliminate the subluxation of the toe and the plantar displacement of the metatarsal head. After osteotomy of the metatarsal bone and lifting its head to the back of the foot, the patient can count not only on the correction of the hammertoe deformity, but also on getting rid of the painful corns on the sole of the foot.
The fixation of the metatarsal bone in the new position after osteotomy is carried out with special Baruk’s or Herbert’s screws. The titanium alloy screws are designed in a special way, and combine great strength with small sizes.
When the screw is tightened, a strong compression is achieved in the osteotomy zone. This type of fixators ensures reliable fixation of the osteotomy zone until the bone fracture is healed completely, due to which the patient can walk in special shoes immediately after the operation. The screw does not disturb the patient in his or her daily life and does not require subsequent removal.
Another frequently used operation, especially for claw toes, is arthrodesis of the interphalangeal joint. Arthrodesis is an operation in which the joint is excised, and the bones that form it are matched with each other in the desired position and rigidly fixed together until their complete fusion.
After the bones have been fused, there are no movements in the area of arthrodesis. During arthrodesis of the interphalangeal joint, the articular areas are excised, the ends of the phalanxes are treated in a special way, the toe is straightened and fixed with a pin in this position for 4 weeks. During this time, the phalangeal bones fuse with each other in a straightened position. Although the range of motion in the interphalangeal joints is limited, it is not so important for the patient and for the function of the foot. The patient notes a significant reduction in pain and discomfort when wearing shoes and a good cosmetic result.
Besides bone operations, various operations are performed on soft tissues, mainly tendons.
After the surgery, the patient, as a rule, wears special shoes for 4-5 weeks. These shoes completely unload the forefoot (toes and metatarsal bones), thereby creating conditions for the quick healing of the wounds and the fusion of the bones in the areas of osteotomies or arthrodesies. Sutures are usually removed on the 12-14 day after the surgery.
Flatfoot valgus deformity of the feet or, as it called by common people, longitudinal flatfoot is one of the most common diseases in adults. The basis of the disease is a gradual, initially reversible, reduction in the height of the medial longitudinal arch of the foot, detected during exercise, and later the formation of the deformity in all the parts of the foot, which is difficult to eliminate and persists at rest.
Flatfoot valgus deformity of the feet may be congenital, but it is more often formed in adulthood. Both hereditary factors and constant significant loads on the feet, for example, with excess body weight or pregnancy, can forward its progression. It has been found out that one of the main causes of longitudinal platypodia is dysfunction of the posterior tibial tendon. This type of platypodia is characterized by a rather pronounced pain syndrome, leg fatigue when walking, as well as difficulties with the choice of shoes.
Flat valgus foot, or longitudinal platypodia, is characterized by a reduction in the medial longitudinal arch of the foot, as well as a progressive deformity and movement disorder in the hindfoot. The flattening of the longitudinal arch and deformity of the hindfoot occur gradually as the disease progresses. First, the decrease in the height of the longitudinal arch and the flatness of the foot can only be seen under load, for example, when the patient is standing. As the load ceases, the shape of the arches and the entire foot is restored.
In the future, the low flattened longitudinal arch of the foot is visually detected without any load, for example, when the patient is lying or sitting. During this stage, there occurs a well-marked deformity of the hindfoot, expressed in a progressive valgus deformity and pronation of the heel bone.
As the disease progresses, further deformity of the hindfoot with pronation and calcaneus valgus are noted, the longitudinal arch of the foot is not visually perceived.
The foot becomes stiff, the range of motion in it is significantly reduced, and the ankle suffers. Changes to the foot at this stage are irreversible without surgical treatment. Patient with such deformities of the feet cannot walk independently, even short distances. It is either impossible or causes severe pain.
The presence of the extra navicular bone of the foot (os tibiale externum) is one of the main reasons for the occurrence of longitudinal platypodia or flatfoot valgus deformity of the feet.
The extra navicular bone is formed in infancy. The cause of the formation of the extra bone is not the fusion of several ossific nuclei responsible for the formation of the navicular bone. On radiographs, it is visualized like two navicular bones, one of which is larger than the other. By itself, the presence of the extra bone is not something dangerous to health and in most people it does not cause any discomfort.
Problems arise only when the extra bone is large in size, or the fibrous connection between the bones is broken in the event of injury, which may lead to the displacement of the main navicular bone relative to the extra one.
Often, after trauma and rupture of the fibrous tissue that connects the navicular bones, there may be excessive mobility of the bones while walking, which also causes pain. Clinically, the patient notes the presence of a hard painful subcutaneous formation on the instep, on the inner edge of the foot in the projection of the navicular bone. Shoes squeeze subcutaneously located large extra navicular bone, which also causes pain and oedema. Degenerative or traumatic injury of the posterior tibial tendon is another reason, and perhaps the most important one, leading to the progression of longitudinal platypodia or flatfoot valgus deformity of the feet.
There are a huge number of operations performed on patients with longitudinal platypodia or flatfoot valgus deformity of the feet.
The unique function of the posterior tibial muscle is that it raises the longitudinal arch of the foot and in a special way fixes this position when walking. If the function of the posterior tibial tendon is impaired for any reason, longitudinal platypodia occurs. In the initial stages of the disease, when the foot is still elastic, and the patient is young, preference is given to the minimally invasive operations. The most low-impact operation used for longitudinal platypodia or flatfoot valgus deformity of the feet, giving an excellent result, is subtalar arthroereisis. The essence of the operation is the insersion of a special implant in the joint area between the heel and the ankle bones.
With longitudinal platypodia or flatfoot valgus deformity, heel hyperpronation is observed, caused by instability and weakening of the ligaments around the subtalar joint. The implant inserted near the subtalar joint blocks heel pronation, resulting in a correction of the height of the longitudinal arch.
Clinically, patients have noted a reduction in pain and fatigue when walking, the restoration of a normal gait, and the elimination of all sorts of restrictions in the selection and wearing of shoes. Artroereisis is usually combined with posterior tibial tendon surgery. If tendinitis or inflammation of the tendon occurs, minimally invasive debridement is performed. The purpose of the operation is to remove thickened, inflamed and damaged tissues in the tendon area.
The operation is performed minimally invasively through small incisions using arthroscopy. After the surgery, the pain syndrome is significantly reduced, as well as the risk of degenerative rupture of the posterior tibial tendon decreases.
When you break the posterior tibial tendon, it needs restoration. With ordinary ruptures, a special suture is placed on the tendon. In cases when the tendon tissue has significant pathological changes, it may be necessary to replace it with a graft. Sometimes the posterior tibial tendon undergoes such significant degenerative changes that its restoration is unpromising. In such cases, instead of the damaged posterior tibial tendon the surgeon transplants the tendon of another muscle on the navicular bone.
For these purposes, the flexor tendon of the toes is used. After the transferred flexor tendon has adhered with the navicular bone of the foot, it begins to work in full instead of the damaged posterior tibial tendon and perform the function of supporting the longitudinal arch of the foot instead of it.
The most commonly used surgical intervention in the treatment for longitudinal platypodia, the cause of which is the presence of the extra navicular bone, is subtalar artroereisis in combination with the fixation of the posterior tibial tendon. At the same time, the extra bone and the inflamed painful tissues around it are removed, and the posterior tibial tendon, which is attached to the extra bone, is cut off and transferred to the main navicular bone.
To fix the posterior tibial tendon, special anchor fixation devices or interference screws may be required. Fixators of these types make it possible to firmly attach the transferred tendon to the navicular bone until its full adhesion. After the surgery, the height of the foot arch is restored, the gait comes to normal, and the pain caused by the presence of the large extra bone in the foot arch is relieved.
In the treatment for longitudinal platypodia or flatfoot valgus deformity of the feet, especially in young patients, various corrective osteotomies are also used. Osteotomy is an operation in which a bone is cut with special instruments, the fragments are displaced and fixed in a new, more advantageous position.
The purpose of the operation is to eliminate the deformity. Osteotomies are more preferable as opposed to arthrodesis, especially in young patients with slight deformity and not much destroyed foot joints. Arthrodesis is actually the excision of the joint with the further fusion of the bones making it up.
Arthrodesis is an induced operation, and it is performed only when other types of operations can no longer help the patient. In orthopedics for longitudinal platypodia and flatfoot valgus deformity of the feet, various types of osteotomies and arthrodesis of one or several joints of the foot are used.
When choosing a surgery, the surgeon takes into account many factors and the patient’s individual characteristics. For example, in practice, a combination of longitudinal and transverse platypodia is often observed, which is manifested by the valgus deformity of the first toe. In such cases, the surgery should be aimed at eliminating all types of deformities.
And finally, in the case of the fixed rigid longitudinal platypodia with severe deformity, the so called triple arthrodesis is required. Triple arthrodesis is most appropriate for the treatment of patients with platypodia in the later stages. This surgery is a kind of “gold standard” in the treatment for foot deformities. This type of operation helps to relieve patients from severe pain caused by arthrosis of the foot joints. During triple arthrodesis, the cartilage from the astragalocalcanean, the talonavicular and calcaneocuboid joints is removed.
Due to the fact that during the surgery, worn, inflamed joints are excised, the patient notes a significant reduction in pain. The operation makes it possible not only to eliminate the deformity, but also to restore and securely fix the longitudinal arch of the foot. The success of the operation also depends largely on the quality of the fixation devices used. During the operation a wide range of metal fixators (pins, braces, screws, plates) of various sizes and shapes is used.
Active people, especially those engaged in sports, often notice pain and oedema near the Achilles tendon and hindfoot. The list of diseases affecting the Achilles tendon is quite extensive. These are tendonitis and tendinosis of the Achilles tendon, lateral bursitis and Haglund’s disease, achillobursitis and many others. Achilles tendon disease is not as harmless as it may seem. Even the rupture of the Achilles tendon can be the outcome of a long course of some of them.
Human foot and ankle have a very complex structure. Together, they function as one unit, providing a stable support for the human body when walking and running. Many muscles and tendons provide movement in the ankle and foot, but the main role belongs to the Achilles tendon. The Achilles tendon is the largest tendon in the human body. The tendon connects the soleus and gastrocnemius muscles with the heel bone.
In the area of the Achilles tendon there are several mucous sacs or bursas. The mucous bursas are filled with fluid and are designed to reduce the Achilles tendon friction with nearby tissues during movements. Sometimes mucous bursas become inflamed and grow in size. The inflammation of the mucous bursa is called bursitis in medicine.
4-5 cm above the site of the Achilles attachment to the heel bone, there is a tendon area most frequently affected by various pathological changes. In this area of the tendon blood supply is poorer than in other areas of the Achilles. Because of this, inflammation of the tendon, or as it is called in medicine, tendonitis, occurs more frequently in this area, and healing after injuries is slower.
Inflammation of the Achilles tendon usually occurs in untrained people of middle age (30-50 years old) after a long unusual load. For example, a man leading a predominantly sedentary lifestyle makes up his mind to go for a long jog on the weekend without warming up. Tendinitis and Achilles perithendinitis can also be experienced by professional athletes because of overtraining or abnormal running techniques.
The cause of Achilles tendinitis is often the long wearing of shoes with a rigid back.
Tendinitis at the site of the Achilles attachment to the heel bone is usually associated with the fact that bone excrescences in the area of the heel bone collide with the Achilles tendon during movements and cause inflammation of the mucous bursa (bursitis).
For the first time this painful condition was described by Haglund, that is why it is called Haglund’s deformity or Haglund’s disease, and the inflammation of the bursa is called retrocalcaneal bursitis. The anatomical deformity of the heel bone at the site of the Achilles tendon attachment, which Haglund described, and which is the cause of inflammation, is usually congenital.
Unfortunately, pain in the Achilles tendon can be quite persistant, and therefore, conservative treatment does not reach the effect.
In case of failure of conservative therapy, surgical treatment is indicated.
There are two distinct surgical procedures for the treatment for Achilles tendon diseases ‒ open and endoscopic.
Open operations in this area are used less and less often. They are often complicated, so we will not dwell on them.
Endoscopic interventions are preferable in connection with a less pronounced pain syndrome, a short recovery period after the surgery, a good cosmetic result, and the possibility of resuming sports in a short while.
The operation is performed through a couple of skin punctures in the area of the Achilles under arthroscopic control. The image from the arthroscope is transmitted through the video camera to the monitor, on which the surgeon can see the inflamed bursa and bone excrescences (osteophytes) of the heel bone. Osteophytes and inflamed tissues in the tendon area are removed with a special shaver device.
For a more delicate isolation and elimination of pathologically changed tissues in the area of the Achilles tendon, cold plasma can also be used. Immediately after the surgery, the patient can walk with almost full load. In a few days, the patient begins to do exercises to restore the movements in the foot. In two weeks the sutures are removed.