Der therapieresistente Fersenschmerz - eine Operationsindikation der Sporttraumatologie

Abstract

Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain.

Case Report: Can Sacroiliac Joint Dysfunction Cause Chronic Achilles Tendinitis?

“…Conservative treatment is effective in most cases. Only in the case of chronic tendinitis is surgical intervention recommended and, even here, authors find a high rate of success (25).…”

“…He was unable to walk on tiptoe or heels, to hop on the right leg, or to jog. Since previous medical and therapeutic interventions had been unsuccessful, the team physician recommended surgical debridement of the inflammed tendon (25). The athlete, however, was against the operation, since the postoperative rehabilitation would take several months and, thus, jeopordize his summer competition schedule.…”

Ermüdungsbrüche im Sport

“…3). Auch Tomographien bilden Ermüdungsbrüche nicht immer zweifelsfrei ab (5,8,11,14,24,27). Bei fehlendem radiologischem Frakturspalt wird von "knöchener Streßreaktion" gesprochen (2,3,36,41).…”