Surgical Treatment of Insertional Achilles Tendinopathy With or Without Endoscopic Gastrocnemius Recession: A Retrospective Comparative Study

Abstract

Purpose: Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain, often associated with Haglund deformity, degenerative changes at the tendon insertion, and gastrocnemius tightness. Standard surgical management includes open debridement, retrocalcaneal bursectomy, calcaneal exostectomy, and Achilles tendon reattachment. The role of adjunct endoscopic gastrocnemius recession (EGR) remains controversial because comparative data on functional outcomes, ankle motion, and complications are limited.

Methods: This single-center retrospective comparative study included patients with chronic IAT who failed ≥3 months of nonoperative management and underwent surgery between January 2019 and December 2023. All patients received open debridement, Haglund resection, retrocalcaneal bursectomy, and double-row reattachment with or without adjunct EGR. Patients were allocated to gastrocnemius (GR, n = 18) or no gastrocnemius (no GR, n = 15) recession groups. Outcomes included VAS pain, FAAM, SF‑36 physical and mental subscales, heel-rise height difference, ankle dorsiflexion, and complications, assessed preoperatively and at three, six, and 12 months postoperatively.

Results: Thirty-three patients were analyzed. At three months postoperatively, the GR group had lower pain, higher FAAM and SF‑36 physical scores, and greater dorsiflexion gains. By 12 months, pain, function, heel-rise symmetry, and complication rates were similar; wound complications and transient nerve symptoms occurred only in the no GR and GR groups, respectively.

Conclusions: Adjunct EGR in IAT surgery provides earlier pain relief, better short-term functional recovery, and sustained dorsiflexion improvement without increasing overall complications and may reduce wound-related problems.