The Surgeons Perspective
I first met Nigel John in 2016 and diagnosed insertional Achilles tendinopathy
He had already worked hard with physiotherapy and we initially augmented this with shock wave therapy. The results initially were excellent but unfortunately his symptoms returned.
Occasionally with this type of problem injections are helpful if the predominant diagnosis is a retrocalcaneal bursa. We try to avoid injecting steroids around the tendon itself as they sometimes weaken the tendon enough to rupture.
If a Haglund deformity is the main issue, removing this extra piece of bone in an open or minimally invasive operation, can solve the problem.
Unfortunately for Nigel John he had a Haglund deformity, retrocalcaneal bursitis and insertional tendinopathy. Having exhausted all non-operative options we decided to proceed with surgery. This involves detaching the tendon from the bone, removing the Haglund deformity and bursa and then re-attaching the tendon. We used all sorts of high-tech tendon anchors as the forces that go through the tendon bone junction are many times body weight. Following surgery he was treated in a boot to protect the repair for 8 weeks. This is very similar to the boots used when the Achilles tendon ruptures spontaneously during sport.
He worked hard at the post-op rehabilitation and I am delighted to see that he is back in the lake district.