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Multiple Services With A Single Focus: Your Success © Copyright 2015. CBIZ, Inc. NYSE Listed: CBZ. All rights reserved. 4040 Embassy Parkway, Suite 100 • Akron, OH 44333 Martha Bethea 330.668.6500 • www.cbiz.com n Efciency reengineering n Financing structure and negotiations n Reimbursement methodologies – risk sharing – bundle payment n Structure for related businesses n Medical practice merger, acquisition, integration n Financial statement preparation and analysis Managing the Recalcitrant Achilles Tendon Recalcitrant Achilles Tendon Recalcitrant Achilles Tendon BY JEFFREY M. WHITAKER, DPM, FACFAS REPETITIVE OVERUSE INJURY to the Achilles tendon, in the absence of appropriate ea rly immobilization, can lead to a chronic, degenerative condi - tion of the tendon referred to as tendinosis or tendinopathy. Tendinosis is characterized by the replacement of normal tendon fibers by fibro-fatty tissue. Fibro-fatty tissue predisposes the tendon to pain, weakness and possible rupture. In addition, this type of degenerative tissue rarely responds to standard conservative care such as immobilization and physical therapy. While there has been an increase in reports describing the use of minimally invasive techniques, such as platelet-rich plasma injections, radiofrequency coblation, extracorporeal shockwave therapy and even micro-tenotomy, aimed at stimulating a replacement of fibro-fatty tissue, MRI-guided open debridement of degenerative tissue and subsequent tendon repair still seem to provide the most reproducible results in the literature. In general, the bridging of a significant Achilles defect caused by open debridement can be accomplished via Achilles allograft, turn-down flaps of the gastrocnemius aponeurosis, or transfer of the flexor hallucis longus (FHL) muscle and tendon. In my opinion, the FHL muscle and tendon transfer has three distinct advantages over the other repair options: + The incorporation of well-vascularized tissue, such as muscle, into a tendon repair site, which should increase the healing potential of the entire soft-tissue construct + A stronger overall construct, since the FHL muscle is left attached to its bony origin, and the FHL tendon is transferred into the calcaneus + The recruitment of an in-phase muscle, which will assist with active plantarflexion during recovery and rehabilitation Dr. Whitaker is board certified by the American Board of Foot and Ankle Surgery and a Fellow of the American College of Foot and Ankle Surgeons. He is Division Head and Associate Professor of Podiatric Surgery at Kent State University College of Podiatric Medicine, in Independence, Ohio. ■ Reference Schon LC, Shores JL, Faro FD, Vora AM, Camire LM, Guyton GP. Flexor hallucis longus tendon transfer in treatment of Achilles tendinosis. J Bone Joint Surg Am. 2013. 95(1): 54-60. M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N n J A N / F E B 2 016 2 1 S P E C I A L S E C T I O N : O R T H O P E D I C S 2 1