Operative indications and cases to be wary of
This is a case of insertional tendonosis with diffuse thickening across the whole posterior heel, medial to lateral. Often there exists calcification within the tendon insertion. This degree of intra-tendinous calcification(1) however is rare. Here the tendon will need to be sharp dissected off the heterotopic calcification(which may extend across much of the width of the calcaneum). The deep insertional fibres attaching to the back of the normal calcaneus will be left largely unaffected. The Achilles is then re-attached as per the following technique using Arthrex Bio-corkscrew anchor. The tendon tissue itself will probably require a measured debridement into the tendon substance as well.