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07/08/2017    Don Peacock, DPM, MS

Calcific Tendonitis

Given the long pain history of your patient pain
it’s doubtful that continued conservative care
will benefit. The x-ray indicates multiple issues
related to posterior heel pain. There is a
Haglund’s deformity, insertional tendinosis,
Achilles calcification, and most likely
retrocalcaneal bursitis.

Additional x-ray finding seem to complicate the
use of orthotics in this case. Orthotics help
posterior heel pain by limiting abnormal motion
and decreasing stress and/or twist of the Achilles
etc. Unfortunately, this patient has a medium CIA
of about 24 and what appears to be a stable rear
foot as noted by x ray findings with resting
stance position. Your patient does not appear to
have a foot type indicative of excessive rear foot
motion seen with most lower CIA flexible patients.

It is possible the patient has a flexible
forefoot causing posterior stress and strain in
which case orthotics would work by using a
posterior post of 0 degrees, a heel lift, a higher
arch fill and a 1st ray cutout to plantarflex the
1st. As always, x-rays alone cannot give this
information. This being said heel lifts would help
this patient to some degree by removing the
gastrocnemius equinus primary etiology.

It is likely that he will require surgical
correction including removal of the Haglund’s,
cleaning up the Achilles and detaching with
reattachment of the Achilles in a more forward
position. This maneuver would essentially lengthen
the Achilles tendon by performing a Murphy’s
movement.

I have had some success by performing just the
gastrocnemius recession and utilizing micro
debridement on the Achilles tendon or shock wave
with these type patients. Looking at the x-rays,
it appears that open removal and detachment with
reattachment of the Achilles would be the best
option

Don Peacock, DPM, MS, Whitesville, NC

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