XXIVe Journée scientifique de
l’AMISEK du samedi 10 décembre 2005
CONTROVERSES EN CHIRURGIE ET
REEDUCATION DE
Chairmans :
Dr M. Jeanjot et M. Y. Xhardez - Président d’honneur : Dr M.
Clemens
Auditoire
de l’Institut Supérieur d’Ergothérapie et de
Kinésithérapie (Haute Ecole P.-H. Spaak)
(former) Chief of department for foot surgery at the
Orthopedic
Hospital Speising in
In pathology of the Achilles tendon
the followinjg entities are distinguished: affections of the tendon sheeths
presenting as acute or chronic paratenonitis (peritendinitis) and of the tendon
itself (tendopathy, tendinosis, tendinitis).
Insertional tendopathy occurs at the tuber cacanei, non insertional at about
four to five centimeters proximal to it. This is an area of reduced blood
supply to the tendon.
Pathology is usually due to overuse
of the tendon in relation to its capacity of endurance. Histologically in
paratenonitis signs of inflammation are found while in tendopathy necrosis is
prevalent. The degenerative alterations in the tendon can finally lead to its
rupture.
Surgery is performed if conservative
therapy fails. In paratenonitis two thirds of the posterior circumference
of the tissue are removed, the anterior third is left intact to preserve
the blood supply to the tendon.
With tendinosis the tendon is combed
by longitudinal incisions and removal of necrotic areas. Recently longitudinal
incisions of the Achilles tendon from several stab wounds of the skin were
found to be useful. The idea is to promote revascularisation and strengthening
by scar formation. If more than fifty percent of the substance of the tendon
has to be removed some kind of augmentation must be applied. Turn down flaps or
tendons of the area, usually the flexor hallucis longus tendon can be used for
that. If, in case of rupture, primary suture seems inadequate or impossible,
the above mentioned procedure and/or lengthening of the tendon by v-y-plasty or
pencil case plasty (a healthy part of the midportion of the tendon is mobilized
and pulled down) will provide for a reliable repair.
Insertional tendinosis is frequently
accompanied by calcaneal bursitis. The usual procedure there will be removal of
the postero-superior edge of the tuber calcanei together with the bursa and
support by transfer of the flexor hallucis longus tendon.