This condition often involves a prominent bump at the back of the heel bone (calcaneus), calcification at the point where the Achilles tendon attaches to the heel bone and inflammation in the surrounding soft tissue. Shoe pressure can lead to considerable discomfort, especially in people with high arches (pes cavus). This discomfort is often accompanied by the sudden occurrence of a sharp, stabbing pain.
What forms of treatment are available?
Treatment usually depends on the extent or stage of the deformity. While those whose condition has reached an advanced stage may experience an alleviation of the pain by resting, lasting improvement can only be achieved via a structural realignment. Such realignment may involve the use of shoe inserts that reposition the heel bone and release the muscles pulling on the Achilles tendon. Cold and heat applications as well as ultrasound treatment (physical therapy) have shown good results, while the use of shockwave therapy has proven to be very effective.
The combination of special shoe inserts and physical therapy often suffices for improvement. However, if these measures fail to bring the desired outcomes, or if the Achilles tendon has clearly sustained significant damage, it will be necessary to consider surgical options. The goal of surgery is usually to narrow the body of the heel bone and to remove the prominent bump under the attachment of the Achilles tendon. If bursitis is also involved, the bursa can be removed during surgery. The long-term prospects of surgery are very encouraging. The use of minimally invasive arthroscopic surgery in this context helps to ensure minimal tissue damage and less post-surgical pain.
Using x-rays as a guide as well as direct visual controls, spurs or other deformities can be removed during arthroscopic surgery. In rare cases, a more extensive surgical realignment of the heel bone may represent the only option for achieving long-term success.
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