Achilles Tendinitis: Bone Spur Removal and Minimally Invasive Achilles Tendon Repair Animation

This animation shows a surgical treatment for insertional achilles tendinitis by removing the bone spur on the back of the heel, called a Haglund's deformity, and then repairing the Achilles tendon back to the bone. On this right foot, the surgeon starts by locating and creating the skin portals to do the surgery. The first step is to make room in front of and behind the achilles tendon. Using a small burr through the portals, the surgeon will shave down the bone spur. When the bone is removed, 2 guide pins are placed in the heel bone through these 2 bottom portals. A drill is then placed over the pin and a hole is created to make room for an anchor that will be placed later in the surgery. Since the heel has very hard bone, a tap is used to make threads in the bone. This makes it easier to insert the anchor. The same steps are repeated for the second pin. Next, the first anchor for the top of the heel, which is made of all suture, is placed in the bone through one of the top portals. A second all suture anchor is then placed through the other top portal. Each anchor has several sutures attached to it. First, these 2 flat sutures that are joined at the end with a needle are passed through the Achilles tendon and through the skin. They will be pulled out from under the skin at a later step. The needle is cut off both sets of sutures and they are put off to the side for now. Next, the rest of the sutures from each anchor are passed through the tendon, crossed over each other and linked together, and then tightened down to hold the top edge of the tendon down to bone. The surgeon does not have to tie any knots with this step. At this point, the 2 flat sutures from each anchor are pulled out from under the skin through each of the top portals. An instrument called a suture passer is used to pull 1 flat suture from each anchor out of each bottom portal. The first set of sutures is loaded into the tip of another anchor, tightened, and inserted into the heel bone through this bottom portal into the hole that was created earlier. There is a little black line on the anchor inserter that tells the surgeon how far to sink the anchor. The same steps are repeated for the second anchor in the bottom portal, making an X pattern holding the tendon in place until it heals. The small portal incisions are stitched closed and the surgery is complete.