How To Repair Calcaneal Step Deformities

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Author(s): 
By Richard Braver, DPM

Your suturing technique is important since you want good tendon to bone apposition. Perform the suturing intra-Achilles so the suture is not stuck between the Achilles and the bone, and so the Achilles is not overly apparent between the Achilles and its covering. Additionally, you should reoppose the medial and lateral halves of the Achilles with a running suture from proximal to distal, using 3-0 vicryl or similar absorbable suture.
If you remove large defects of the Achilles, then it is acceptable to repair them by using 3-0 non-absorbable suture in simple interrupted technique. Lay the paratenon and/or subcutaneous tissues over the Achilles and again suture with a similar non-absorbable 4-0 running suturing technique. Perform skin closure with a running 5-0 prolene or skin stapling technique at your discretion.
What About The Post-Operative Course?
Dress the patient’s wound appropriately and place it in a below knee fiberglass cast with the foot positioned at 90 degrees to the leg for three weeks. Then remove the cast and put the patient in a below knee boot cast.
These patients should remain non-weightbearing for one week while attending physical therapy. At this time, they progress to partial weightbearing in the boot cast. At approximately six weeks, place the patient back in sneakers. A course of physical therapy is absolutely necessary for up to three months. Please advise your patients the healing process does require three to six months of rest from sports. However, patients are usually walking well after eight to 12 weeks.
Final Notes
In summary, the beauty of this incisional approach is that while you retract the medial and lateral halves of the Achilles tendon with Army/Navy retractors, you get a clear view of the retrocalcaneal exostoses and can easily remove them. In addition, you can maintain the distal medial and distal lateral insertional areas of the Achilles.
This procedure is technically easy to perform. However, you should perform meticulous dissection and evaluate the anatomical sites intra-operatively. Following the above guidelines should offer exceptionally good results as patients should be able to make a full return to sports.




References:

References
1. Carter, Steven. A New Technique for Resection of the Posterior Calcaneal Spur. Podiatry Institute News, Page 2. October 2000.
2. Braver, Richard. Surgical Solutions for Treating Posterior Heel Deformites. Podiatry Today. Pages 23 – 26, January 2001.
3. Fiamengo, Steven and Warren, Russell. Posterior heel pain associated with a calcaneal step and achilles tendon calcification. Clinical Orthopaedics and Related Research, No. 167, Pages 203-211. July 1982.

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