The Incidence and Clinical Utilization of the Calcific Spur in patients with Insertional Achilles Tendinopathy

Category: Hindfoot Introduction/Purpose: Retrospective review of 38 patients treated by two F&A surgeons from 2009 - 2017 for insertional calcific Achilles tendinopathy to determine the location of the calcific spur. We hypothesize that the spur is most commonly seen affecting the posterior fibers. Our secondary hypothesis was that three-dimensional imaging would allow patients to be identified with less than 50% involvement which would make them eligible for resection without the need for reattachment. Methods: Patients with calcific Achilles tendonitis were identified by ICD-10. Patients were included if they had both calcification identified on xrays and MRI imaging. Patients with prior surgery or trauma to the calcaneus or Achilles were excluded. The axial MRI section with the largest cross section of the calcification was used and a line was drawn sagittally and coronally to divide the tendon into four quadrants to identify laterality and anterior vs posterior involvement. Results: There was no significant difference in anatomic location or laterality of the spur between men and women. Seventy five percent of the patients had a spur that encompassed 50% or less of the insertion site. The predominant configuration was posterior in 89.5%, with half of those being lateral and the rest being central or medial. Eighty percent underwent operative management, with two thirds managed by one surgeon and the remaining by the other surgeon. Conclusion: Three dimensional imaging may guide surgical management in treatment of these conditions by identifying those spurs that are predominantly posterior and can be removed without necessitating the need for formal reattachment. This allows for shorter recovery time for the patient and perhaps improved patient outcomes and satisfaction