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Retro-calcaneal bursae

Discussion in 'Biomechanics, Sports and Foot orthoses' started by andy, Oct 11, 2004.

  1. andy

    andy Member


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    Hi,

    I have a number of patients with posterior heel pain with a confirmed diagnosis of retro-calcaneal bursitis via MRi and US. I know there is considerable debate with regards to injectable corticosteroids near the achilles tendon but i have injected a number using high resolution ultrasound combined with orthoses with a good success rate!.

    I would be grateful if there are any comments?

    cheers

    Andy
    Andrew Williams
     
  2. davidh

    davidh Podiatry Arena Veteran

    Hi Andy,
    I don't use this modality (cortisone) myself, although it is used in conjunction with my orthoses on high-profile soccer players (who need to be fit "yesterday").
    My observations are that targetting with ultrasound gives a far better chance of hitting the mark, allowing less cortisone to be used, and less risk of adjacent tissue trauma :)
    That said, it would be interesting to examine if condition resolution was much better than with orthoses alone.
    Does anyone know of any research on this topic?
    Cheers,
    David
     
  3. podrick

    podrick Active Member

    injection via ultrasound

    hi,
    in the us,cortisone injections in the retrocalcaneal bursal area are considered to be against standard of care.considering our current malpractice environment it is rarely attempted.
    however,i have heard of some practitioners attaining success utilizing other non-steroidal cocktails.i wonder if anyone knows anything about this sort of treatment.

    thanks,

    rick
     
  4. Matt Dilnot

    Matt Dilnot Member

    Articles on Cortisone and Achilles rupture

    Can anyone quote any decent papers on cortisone and achilles rupture? Not retrospective studies and well controlled/documented cases.

    Matt
     
  5. andy

    andy Member

    Dear All,

    I think it is fair to say that the overall consensus injecting directly into the achilles tendon is contrainidicated however i have seen it done!. There are a number of papers but i am not sure about RCT's. There is also debate here in the uk about injecting the retro calcaneal burase which is why i only use it in intractable cases using US guidance. However i would welcome any further opinion on this.

    many thanks

    Andy
    Andrew Williams
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Clinical anatomy of the retrocalcaneal bursa.
    Kachlik D, Baca V, Cepelik M, Hajek P, Mandys V, Musil V, Skala P, Stingl J.
    Surg Radiol Anat. 2008 Jun;30(4):347-53.
     
  7. drsarbes

    drsarbes Well-Known Member

    Hi Andy:

    In my experience: When a patient has failed to respond any other way (PT, Orthotics, NSAI's, etc....) and the next treatment is surgery, I do inject a small amount of cortisone.

    I do on occasion get rather good results, at which point I inform the patient that I am not opposed to giving them UP TO 2 injections per year if that will keep them comfortable.

    As I'm sure you know there is quite a variation in what the underlying pathology is and what exactly is causing the pain. I do not inject the tendon proper and I do not get at the actual attachemnt of the achilles to the os calcis.

    Peritendon or intrabursae injections seems to work with some regularity. SOme patients do well long term, others do not.

    When there is obvious retrocalcaneal spurring with enlarged superior angle, surgical debridement can be successful.

    Steve
     
  8. physiocolin

    physiocolin Active Member

    Hi Andy

    The CSP lays down robust guidelines for us physios using injection therapy, in addition to obtaining the diploma in Injection Therapy. In the instance of any patient struggling to make progress from conservative interventions,with a well established recalitrant pathology, then there is a good case to use injection therapy. It may be that it is used as differential diagnosis.
    If confident with anatomical placement and relations and using minimal dose of steroid, slightly bulked up with the addition of anaesthetic then the procedure is pretty straightforward, without imagery support. I have injected quite a number over the past 12 years with good results (i.e returned to normal activity). My protocol involves 4 days partial weight bearing, 3 days low grade walking before reviewing at 1 week. Patient comfort at this stage would direct the follow on rehab. Any additional intervention would depend on the biomechanical assessment.
    PhysioColin
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Minimally invasive retrocalcaneal bursa pressure measurement: development and pilot application.
    Lohrer H, Raabe T, Nauck T, Arentz S.
    Arch Orthop Trauma Surg. 2010 Dec 16. [Epub ahead of print]
     
  10. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Minimally invasive retrocalcaneal bursa pressure measurement: development and pilot application.
    Lohrer H, Raabe T, Nauck T, Arentz S.
    Arch Orthop Trauma Surg. 2011 May;131(5):719-23.
     
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