Posterior heel pain is a difficult and complex thing to diagnose and to treat. There are so many potential issues that can cause it. Retrocalcaneal Exostosis is one condition which can cause heel pain and unfortunately it is one of the most difficult ones to treat. The treatment for it is surgery, but unlike other surgeries for heel issues, it can be quite a complex treatment.
Treating the condition requires removing the exostosis. This means using an incision through a part of the tendinous substance that makes up the Achilles tendon. The condition affects people of all ages, and this means that recovery times can vary massively.
Depending on the severity of the condition the surgery may remove just the bump, or remove the bump and a portion of the calcaneus. The latter type of surgery is usually found to have a better long term outcome, however, because the Achilles tendon needs to be cut into, and sometimes removed then reattached as a part of the procedure this can produce very long healing times.
What Happens After The Procedure
Following the surgery, the foot will be immobilized for six weeks. This is necessary because the Achilles tendon has a very poor blood supply and as such, it can take a long time to heal. Good post-operative care is required in order to prevent complications. Once the tendon has healed, the next step is to begin a period of physiotherapy to restore strength and range of motion to the ankle.
Common Complications of Surgery
The procedure is a difficult one, and there are a number of possible complications which can make the recovery times even longer. Since the surgery can involve temporary detachment of the Achilles tendon, there is always the risk that then tendon could rupture. This risk can be reduced if proper aftercare procedures are followed.
Another possible complication is postoperative tendonitis. This is relatively common and will occur when the patient starts to walk, unsupported, on the treated foot. Typically, the condition will resolve itself within four months as long as the patient is diligent with physiotherapy.
If it does not resolve itself, then it will be treated as a standard case of tendonitis initially and then if it still does not recover the surgeon will need to consider the possibility that there could be other conditions affecting the heel. One potential issue is excessive subcutaneous scarring because of the nature of the incision that was made to reach the calcaneal.
If the surgery can be completed with a simple Y or inverted V extension heading through the deeper structures, then this could minimize scarring.
Is the Procedure Worthwhile?
Retrocalcaneal exostosis surgery is typically recommended if rest, orthotics and physical therapy is not enough to manage the heel pain that the patient is feeling. It is used in extreme cases, where the risk/reward makes it worthwhile. When the surgery is successful, it can result in complete pain relief for the patient.
The surgery has a high success rate when postoperative care procedures are followed, and it is up to the patient to balance the potential for permanent pain relief with the long recovery time following the operation. Talk to your doctor and the surgeon to find out whether they suspect there could be any issues with your surgery, and consider how the condition you have right now is affecting your day to day life.
The surgery has improved a lot in recent years as podiatrists have learned the best approaches to working with the tendon, so for most, it would make sense to have the procedure if they are suffering from chronic pain.