THE CLINIC: Should I Have Heel Surgery?

Thu, 13 Sept. 2012 - 1:01 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
I am a 63-year-old male runner, 5’ 11”, 188 lbs, who hasn’t done much of it in the last six months due to persistent pain along my left heel. My DPM took an x-ray and found a calcium build-up where the Achilles attaches to the heel. He recommended a device called a silicone sock, Tylenol, and stretching (toes on stairstep, drop heel, hold for 10 seconds). Because I am diabetic, he did not recommend surgery due to possible complications and the added time to heal. I would like other opinions on this recommendation. Is there a history of successful surgery for problems like this in people over 60 with diabetes?
 
Michael O’Mara
Westlake, Ohio
 
ANSWER:
I agree that surgery should be held out as a last choice, but I would not rule it out (assuming your primary doctor clears you). There are more conservative options to be explored, however. Aggressive physical therapy and a heel lift will usually do the trick. Note that even religious adherence to at-home exercise and an experienced physical therapist do not mitigate the fact that it can take up to six months to see results. The healing depends on many factors, including the control of your diabetes—high glucose levels impair healing, even with rest and therapy.
 
Surgery is an option if this fails, but there is increased risk of infection and almost certainly delayed healing afterward. A thorough discussion of these risks and a team effort among you, your primary doctor, and the surgeon should make surgery possible, however.
 
Bradley Wadington, DPM, FACFAS
Hendersonville, NC
 
ANSWER:
These Achilles tendon spurs are very painful and difficult to resolve. Diabetes further complicates things by reducing blood flow, decreasing nerve sensation, and lowering immune response. If your blood sugar is managed well and you have good circulation you may do fine with surgery and its relatively long recovery. In addition to orthotics, PT, and rest, you might try a plantarfascial night splint to aid in stretching the Achilles tendon. Also, extracorporeal shockwave therapy, which is investigational and not yet FDA-approved for this body site, has nevertheless yielded promising results; check with physicians in your area to learn more about this procedure.
 
Lori Barnett, ATC, DPM, FACFAS
New Tripoli, PA


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(RUNNING & FITNEWS® September/October 2006 • Volume 24, Number 3)



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