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Pain in the Heel

by Vince Vacketta, DPM

In recent study on the epidemiology of insertional and mid portion Achilles tendinopathy in runners, authors Wenbo Chen et al., 2023 asked 3,400 recreational runners who had previously signed up for an organized event to map and rate their discomfort in their Achilles tendons.

During the first 20 weeks of training, the overall occurrence of new onset Achilles pain was 4.2%. Specifically, 64% of the runners experienced mid portion pain, 28% experienced insertional pain, and the remaining runners reported a mix of different types of pain.

Insertional Achilles tendon (IAT) repair constructs

In the US, the majority of IAT surgeries will or should be outpatient procedures performed in ambulatory surgical centers. One argument in favor of double row fixation is its biomechanical superiority. However, there is also the consideration of cost containment on the opposite side.

In another retrospective comparative study of more than 100 patients with CIAT, no statistically significant differences in patient outcomes were found between single anchor and double row repair, as measured by complications and revisions. Not surprisingly, however, the authors did find significant cost savings when comparing the two models, with the double row technique resulting in average expenses of four times greater than that of the single anchor technique.

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