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Achilles Tendon Bursitis or Tendinitis — Ankle Minimally Invasive Surgery: treatment in the Best Hospitals of Germany

St. Vinzenz Hospital for Orthopedics Duesseldorf

9.9/10
location_onGermany, Duesseldorf

Department of Adult and Pediatric Orthopedics, Foot Surgery

The Department of Adult and Pediatric Orthopedics, Foot Surgery offers the widest range of modern medical services to patients suffering from musculoskeletal diseases. The department specializes in knee and hip replacement surgery, including revision interventions to replace previously implanted artificial joints. The department has the status of a certified Maximum Care Endoprosthetics Center (endoCert), which means adherence to the requirements of European professional societies for carrying out procedures of this kind, a high level of safety and treatment efficiency. It is worth noting that the department uses the innovative ROSA® robotic system for performing knee replacement surgery. A special Rapid Recovery Program is used for the rapid recovery of mobility after joint surgery, which allows the patients to quickly return to their usual life. An integral part of the department's clinical practice is also the treatment of foot diseases and deformities in adults and children. The medical facility has been operating for more than 50 years, and therefore it provides patients with the highest quality medical care and easily copes even with highly severe pathologies.

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Vitos Orthopedic Clinic Kassel

9.2/10
location_onGermany, Kassel

Department of Adult and Pediatric General Orthopedics, Trauma Surgery

The Department of Adult and Pediatric General Orthopedics, Trauma Surgery offers the full range of diagnostics and treatment of musculoskeletal pathologies. The specialization covers joint replacement surgery, foot and hand surgery, shoulder surgery, treatment of rheumatic joint lesions, treatment of injuries, sports orthopedics, treatment of orthopedic problems in children and adolescents, as well as pain therapy. The key to successful clinical practice is the highest professionalism and unique experience of the department's medical team combined with the very latest infrastructure and advanced equipment.

University Hospital Ulm

9.2/10
location_onGermany, Ulm

Department of Adult and Pediatric Orthopedics

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics ranks among the top German departments specializing in joint replacement surgery! The department covers the full range of conservative and operative therapy in diseases of the musculoskeletal system, including the special pain therapy in the case of these pathologies, emergency treatment and long-term care for the patients with paraplegia. The department offers many sparing minimally invasive techniques, advanced navigation systems for high-precision interventions.

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

Department of Adult and Pediatric Orthopedics, Special Orthopedic Surgery and Rheumatic Orthopedics

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics, Special Orthopedic Surgery and Rheumatic Orthopedics ranks among the top German medical facilities specializing in the treatment of orthopedic diseases in adults and children, as well as in hip surgery! The department offers the full range of medical services in these medical fields. It carries out both diagnostics and treatment of patients of all age groups, including very elderly patients, with various musculoskeletal diseases. The therapeutic options include both conservative and surgical treatment methods. The department is distinguished by high professionalism of doctors, advanced infrastructure and invaluable experience in the field of its specialization, due to which it occupies leading positions in the European medical arena and guarantees an optimal treatment result.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of Adult and Pediatric Orthopedics, Traumatology

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics, Traumatology ranks among the top German departments specializing in endoprosthetic joint replacement! The department offers the full range of services in the field of diagnostics and treatment of all diseases of the musculoskeletal system. In addition to surgical treatment, a number of effective conservative treatments are available in the department, for example, physiotherapy, occupational therapy, therapeutic exercise. The highly qualified doctors who have a rich experience and outstanding treatment results take care of the patients' health. 

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

Department of Adult and Pediatric Orthopedics, Foot Surgery

The Department of Adult and Pediatric Orthopedics, Foot Surgery offers the full range of services for the diagnostics and treatment of musculoskeletal diseases: bone, joint, muscle, ligament and tendon diseases. Special attention in the department's clinical practice is paid to knee and hip replacement surgery, including revision interventions to replace previously implanted prostheses, treatment of foot diseases, musculoskeletal cancers, orthopedic diseases in children. In addition, the department's specialists deal with the treatment of rare and especially complex musculoskeletal diseases. The department's highly specialized medical team applies only modern diagnostic and therapeutic techniques in their practice, and the long-term experience of doctors guarantees top-class surgical and conservative treatment. As a certified Maximum Care Endoprosthetics Center, the department's doctors annually perform more than 1,000 surgical procedures for partial and total joint replacement. Every year, more than 10,000 patients entrust their health to the department's medical team. Whenever required, doctors from related medical specialties are involved in the treatment process. The main goal and focus of doctors is to maximally restore the patient's health and give him the opportunity to return to his usual way of life.

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

Department of Adult and Pediatric Orthopedics

The Department of Adult and Pediatric Orthopedics is the center of maximum orthopedic care and offers the diagnostics and treatment of all diseases and injuries of the musculoskeletal system. Along with the full range of modern operative and conservative orthopedics, the department specializes in hip and knee replacement surgery using the minimally invasive methods, replacement/revision of prostheses, orthopaedic oncology, foot surgery and patella problems in the patella.

University Hospital Carl Gustav Carus Dresden

9.1/10
location_onGermany, Dresden

Department of Adult and Pediatric Orthopedics, Trauma Surgery, Foot Surgery

The Department of Adult and Pediatric Orthopedics, Trauma Surgery, Foot Surgery offers the full range of diagnostics, conservative and surgical treatment of musculoskeletal diseases and injuries. The department is a certified Endoprosthetics Center – more than 1,000 primary joint replacement surgeries are performed here annually. The surgeons of the Endoprosthetics Center also specialize in particularly complex clinical cases and revision procedures for the replacement of previously implanted artificial joints. In addition, the department has the status of the interregional Trauma Center certified in accordance with the standards of the German Trauma Society. The department has also been awarded a Certificate of Excellence from the German Orthopedic Foot and Ankle Society (DAF) in the field of foot surgery. A separate area of ​​clinical activity is the treatment of diseases, injuries and congenital malformations of the musculoskeletal system in children. Depending on the severity of the clinical case, both conservative and surgical techniques are used in the treatment of orthopedic pathologies in children. The department's medical team prefers sparing low-traumatic surgery, while open operations are performed only if other therapeutic options are ineffective.

University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

Department of Adult and Pediatric Orthopedics

The Department of Adult and Pediatric Orthopedics offers the full range of modern diagnostics and treatment of diseases, deformities of the musculoskeletal system in patients of all age groups. The priority task of all specialists of the department is to preserve the mobility of the patient and improve the quality of his life. In the field of surgical treatment, the main focus is on joint arthroplasty, resection of musculoskeletal tumors, as well as surgical correction of spinal defects and pathologies. In addition, the department specializes in the treatment of sports injuries.

University Hospital Muenster

9.8/10
location_onGermany, Muenster

Department of General Orthopedics and Orthopedic Oncology

The Department of General Orthopedics and Orthopedic Oncology offers the full range of conservative and surgical treatment of all musculoskeletal diseases. The department ranks among the largest medical facilities of this kind in Germany, as well as among the specialized authoritative departments for the treatment of bone and soft tissue tumors in the European medical arena. The treatment is carried out both on an outpatient and inpatient basis, including the outpatient operations. In addition to its successful clinical activities, the department is proud of its productive research work, which has given birth to many innovations in orthopedics, for example, the department's specialists have patented the very latest prosthetic systems, particularly in the field of orthopedic oncology.

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of Adult and Pediatric Orthopedics, Foot Surgery

The Department of Adult and Pediatric Orthopedics, Foot Surgery carries out accurate diagnostics, effective conservative and surgical treatment of the full range of diseases of the musculoskeletal system. The department's medical team's responsibilities also include physiotherapy and rehabilitation activities. Surgery for orthopedic diseases is performed in state-of-the-art operating rooms equipped for sparing minimally invasive and arthroscopic interventions. There are also treatment rooms for physiotherapy, including a room with a pool for swimming and physical exercises in the water, and rooms with modern exercise equipment. The excellent infrastructure allows doctors to provide high-quality treatment of diseases of the joints, tendons, and bones, thereby restoring patient mobility as quickly as possible. The department admits patients of all age groups, including children and adolescents. The medical facility has been awarded many prestigious quality certificates, including DGOU, endoCert, and EPRD certificates, and has an impeccable reputation in Germany.

University Hospital RWTH Aachen

8.5/10
location_onGermany, Aachen

Department of Adult and Pediatric Orthopedics

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics ranks among the top German medical facilities specializing in joint replacement surgery! The department offers the full range of diagnostics and treatment for patients with musculoskeletal diseases. The department treats patients of all age groups ranging from young children to elderly people. The department annually treats more than 15,000 patients, and also performs about 1,500 interventions yearly. The department has long traditions, long successful clinical experience, which contributes to its reputable status in the medical arena.

University Hospital Marburg UKGM

8.6/10
location_onGermany, Marburg

Department of Orthopedics and Traumatology

According to the Focus magazine, the Department of Orthopedics and Traumatology ranks among the top German medical facilities specializing in the treatment of injuries of any severity! The department offers the full range of diagnostic and therapeutic services to patients with diseases and injuries of the musculoskeletal system. The department has been certified by the German Society of Traumatology as a supra-regional Trauma Center. In addition, the medical institution is a certified Center for Gerontological Traumatology, the Center for Arthroscopy and Joint Surgery.

University Hospital Jena

8.9/10
location_onGermany, Jena

Department of Adult and Pediatric Trauma, Hand, Reconstructive Surgery

The Department of Adult and Pediatric Trauma, Hand, Reconstructive Surgery offers all modern surgical interventions in these medical fields. The department specializes in the treatment of patients with polytrauma, pelvic surgery, endoprosthetics, cancer, reconstructive surgery and hand surgery. The department has 62 beds for inpatient treatment and 3 high-tech operating rooms for both planned and emergency operations. The prestigious certificates of the Interregional Trauma Center of the German Society of Traumatology and the EndoCert certificate testify to the outstanding quality of medical services.

University Hospital Halle (Saale)

9.6/10
location_onGermany, Halle

Department of Orthopedics, Trauma and Reconstructive Surgery

The Department of Orthopedics, Trauma and Reconstructive Surgery offers the full range of modern diagnostic examinations, conservative and surgical treatment of the musculoskeletal system. The competence also includes round-the-clock medical care for patients with severe and multiple injuries. The department operates a certified Endoprosthetics Center, within which the patients undergo knee, hip and shoulder replacement surgeries. All the department's doctors have excellent qualifications and they are recognized experts in their field of competence, which guarantees the highest quality of medical service.

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

Department of Adult and Pediatric Orthopedics

According to the Focus magazine, the Department of Adult and Pediatric Orthopedics ranks among the top German departments specializing in joint replacement surgery! The department offers the full range of diagnostics and treatment of various diseases, injuries of the musculoskeletal system, and their consequences. Also, the department's doctors specialize in sports orthopedics and treatment of orthopedic diseases in children of all age groups. The doctors have in their arsenal many conservative and surgical treatment methods. Many complex operations are carried out using a highly accurate computerized system

Achilles tendon diseases and injuries lead to chronic pain and loss of supportability of the foot. They are treated with conservative methods whenever possible, but sometimes conservative therapy does not help or gives only temporary results. In such a situation, the patient requires surgical intervention. In Germany, preference is given to minimally invasive endoscopic techniques. Such interventions are less traumatic, safer, and easier to tolerate by the patient. Due to the milder traumatization, recovery is faster, and patients can start rehabilitation earlier and return to sports training in the shortest possible time.

Content

  1. Achilles tendonitis and bursitis
  2. Surgery for tendonitis and bursitis
  3. Surgery for tendon rupture
  4. Treatment of Haglund's deformity
  5. Benefits of minimally invasive surgery
  6. After surgery
  7. Where is it better to undergo treatment

Achilles tendonitis and bursitis

 

The Achilles (calcaneal) tendon is the largest in the human body. Its injury or inflammation impairs the support of the lower extremity. Achilles tendonitis is common in athletes and physically active young people. One-third of all cases of tendon pathology is localized in the distal (lower) third.

Degenerative and dystrophic changes in the Achilles tendon are called tendinopathies. There are three main pathologies in this group of diseases: retrocalcaneal bursitis, Haglund's syndrome (deformity), and Achilles tendon enthesopathy.

In 1928, Patrick Haglund described various Achilles tendon lesions and identified individual diseases, including Achilles tendon ossification and Achilles tendon bursitis. He drew attention to two tendon bags: between the calcaneus and the skin, between the Achilles tendon and the calcaneus. These bags are called bursae. Their inflammation is called bursitis. Since the tendon is located nearby, bursitis and tendonitis often develop simultaneously. Such forms of the disease are called Achilles bursitis.

Tendonitis develops gradually as a result of prolonged microtrauma. Its causes may be:

  • weak tendons;
  • irrationally organized physical exercises;
  • poorly-fitting shoes.

The part of the Achilles tendon located at a distance of 4-6 cm from the fixation site is subjected to the greatest loads. It is poorly supplied with blood and does not regenerate well.

There is a hereditary predisposition to the development of tendonitis and bursitis. Approximately one in three people have a ventral attachment of the tendon of the long plantar muscle to the Achilles tendon. As a result, the tendon bursa is constantly irritated under load, which leads to bursitis.

The risk of Achilles  tendonitis and bursitis increases with poorly organized physical exercises, excessively long running distances, and a sharp change in the training program. Tendon injuries are often caused by too rapid forcing of the athlete's speed and strength qualities.

Surgery for tendonitis and bursitis

 

If acute tendonitis and bursitis respond well to conservative therapy, chronic tendonitis usually requires surgery. It is performed when tendon tissue degeneration signs are detected, and scar tissue grows.

Doctors abroad perform minimally invasive surgery on the Achilles tendon. They dissect scars and adhesions. It is possible to cut the fascia to slide the tendon and improve its blood supply.

Bursitis usually requires excision of the tendon bursa.

Tenotomy is performed to treat tendonitis: doctors excise the area of ​​tendon degeneration, and then the resulting defect is sutured. However, not always the ends can be connected and sutured. Tenotomy may sometimes leave an extensive defect, which must be replaced with a graft. In this case, plastic surgery is performed with autologous donor tendons or synthetic materials.

In most cases, surgeons repair the tendon with autoplasty. The patient's ankle is under a great load, as most of them are athletes or just physically active people. For the ankle not to suffer, the tendon must be strong. Therefore, the treatment for Achilles tendon involves the use of the strongest patient's tissues. They are characterized by good engraftment and reduce the risk of recurrent injury. Donor tendon transplantation ensures adequate blood circulation in the tissues. Surgeons most often perform autoplasty with fragments from the proximal part of the Achilles tendon, muscle, and extensor expansion of the gastrocnemius muscle, and less often – the tendon of the long plantar, long or short peroneus muscle.

Alloplasty can restore ankle function in patients with low physical activity. Donor tendon preservation slightly reduces its strength. On the other hand, there is no need to inflict additional trauma on the part of the donor site (parts of the body from which the tendon is taken for transplantation), making the treatment more sparing and safer for health.

Some medical clinics perform surgery to restore the ankle function by Achilles tendon plastic surgery with synthetic materials: nylon, dacron, lavsan, marlex, carbon fibers, etc. Their use is less physiological, and therefore the artificial tendon implantation may cause joint inflammation. However, the quality of materials has improved in recent years, so the risk of complications is reduced, and the recreated tendons are pretty strong.

Surgery for tendon rupture

 

Achilles tendon ruptures are common in sports. They account for up to a third of all tendon injuries in the musculoskeletal system. The attempts to suture the tendon have been known since the time of Galen (II-III century AD). The frequency of ruptures had increased sharply since the 20th century when people began to play sports. Today, Achilles tendon injuries account for 10% of all sports injuries.

The injuries can be fresh or old. Old injuries are considered to be injuries received more than two weeks ago. By this time, granulation tissue is formed, and the ends of the tendon diverge due to the contraction of the triceps surae muscle of the calf. It becomes more complex to suture.

There are conservative treatment methods for tendon ruptures. However, therapy continues for a long time: up to 12 weeks, the patient needs to walk in a cast. During this time, muscle atrophy occurs. In addition, the tendon's sliding ability is impaired, the ankle joint's stiffness develops, and the risk of recurrent rupture during sports increases. Therefore, in patients with high requirements for a functional outcome, conservative treatment tactics are not applicable, and surgical intervention is required for the treatment of the disease.

Tendon suture. It is used for Achilles tendon injury less than two weeks. There are more than 40 ways of suturing. After suturing, the tendon gradually fuses.

Autograft restoration. It is used in case of rupture or degenerative changes in the tendons. They cannot be sutured reliably, so doctors take a piece of tissue from the upper part of the Achilles tendon and suture it to the torn part.

Tendon plastic surgery. It is required for old injuries. More than 80 types of plastic surgery are known. Doctors use a variety of materials to repair the tendon:

  • patient's tendons (autograft);
  • donor preserved tendons (allograft);
  • animal tendons (xenograft);
  • synthetic materials.

Treatment of Haglund's deformity

 

The cause of tendon inflammation may be chronic damage by the bony growth on the back of the calcaneus. This disease is one of the most common causes of back pain.

Surgical treatment can be performed with open or endoscopic techniques. In addition, minimally invasive percutaneous surgery is used for Haglund's deformity. It is performed through skin punctures under X-ray or ultrasound guidance.

A third of patients have a deformity on both legs at once. Such patients require bilateral surgery.

The open surgical technique involves resectioning the superior posterior part of the calcaneus or wedge osteotomy of the heel. The surgery involves the excision of the bursa because if it is left, it becomes the cause of chronic pain. This operation is traumatic, leading to the formation of an unaesthetic scar, sometimes complicated by a calcaneal fracture. The risk of stiffness of the Achilles tendon with limited dorsiflexion of the foot remains. In 30% of cases, there are problems with the healing of the postoperative wound.

Minimally invasive surgery is sparing and less risky. Therefore, such interventions are gradually replacing open ones in developed countries. The operation is performed through a small vertical skin incision. The part of the calcaneus is destroyed with a shaver (a rotating instrument). In addition, surgeons perform the resection of the damaged bursa. The intervention is arthroscopically controlled: the doctor uses a mini camera to accurately and safely perform the necessary manipulations. During the operation, the doctor has the opportunity to examine the upper surface of the heel and remove scar tissue.

Benefits of minimally invasive surgery

 

Doctors perform both open and minimally invasive surgeries to treat Achilles tendon diseases.

Endoscopic interventions are technically more complex. They are not performed in every clinic. However, they have advantages over open surgery. Short incisions are used for access. The trauma rate of the intervention is reduced. After surgery, patients can begin recovery faster, avoiding significant muscle atrophy and decreased range of motion in the ankle joint.

In addition, endoscopic surgery has the following benefits:

  • it is performed faster;
  • it reduces the risk of infectious complications by four times;
  • it reduces the risk of skin sensitivity disorder by almost two times;
  • the risk of postoperative scar hypersensitivity is 2,5 times lower;
  • damages to the sural nerve, plantar tendon, and medial Achilles tendon are less likely to occur.

After surgery

 

The patient needs orthopaedic rehabilitation after surgery. Its duration depends on the type of operation. After an open intervention, recovery usually takes up to 3,5 months. After minimally invasive surgery, patients recover faster: about two months. However, you can switch to maximum sports loads no earlier than after 5-6 months, and after the treatment of chronic tendon ruptures, recovery can take up to 9 months.

In the early postoperative period, limb immobilization is performed. Doctors use the procedures to improve blood circulation, relieve muscle atrophy, maintain ankle mobility, and prevent adhesions. The specialists use physiotherapy, pneumatic compression, massage, therapeutic exercises, and electromyostimulation.

After the end of the period of immobilization, the further goal of orthopaedic rehabilitation is to restore the supportability of the limb and increase the range of motion in the ankle. The primary method is therapeutic exercises. Resistance exercises for the muscles of the lower leg are used. Walking movements are practiced.

Where is it better to undergo treatment

 

You can undergo treatment in one of the German medical centers. Surgeons in this country perform the latest orthopaedic surgeries for tendonitis, bursitis, Achilles tendon rupture. Here are a few reasons for you to use the services of German doctors:

  • high-precision diagnostics allows for detecting the causes of inflammation of the tendon and tendon bursa;
  • minimally invasive surgery through short incisions;
  • vast experience in the use of endoscopic equipment;
  • minimal risk of injury to important nerves, vessels, and tendons during surgery due to the high qualification of surgeons;
  • comprehensive early rehabilitation and well-performed pain management.

The type of operation is chosen individually, depending on the nature of the disease or injury, its duration, severity, and the requirements for the treatment outcomes. If it is required to obtain a donor tendon for Achilles plastic surgery, this operation is also performed using a minimally invasive endoscopic method.

Please use the Booking Health service to undergo treatment at the best hospitals for surgery in Germany. On our website, you have the opportunity to get up-to-date and accurate information about the cost of surgery in Germany, compare prices in different German hospitals and book a program at a favorable price. The treatment will be easier and faster for you, and the cost of treatment in Germany will be lower.

You are welcome to leave your request on the Booking Health website. Our employee will contact you, consult, and answer all questions. We will take care of the organization of your trip abroad. We will provide the following benefits for you:

  • We will select the best German hospital, whose doctors specialize in minimally invasive ankle surgery and achieve the best results.
  • We will help you overcome the language barrier and establish communication with the doctor of the German hospital.
  • We will reduce the waiting period for treatment, and you will receive medical care on the most suitable dates.
  • We will reduce the price. The cost of treatment in Germany will be lower than usual due to the lack of overpricing and coefficients for foreign patients.
  • Our experts will solve any organizational issues: paperwork, transfer from the airport to the German hospital and back, hotel booking, and interpreting services.
  • We will prepare your medical documents and translate them into English or German. You do not have to undergo previously performed diagnostic procedures.
  • We will keep in contact with the German hospital after the completion of treatment.
  • We will organize additional diagnostics and treatment, if necessary.
  • We will buy medicines in another country and forward them to your native country.

While the best specialists in the world take care of your health, the Booking Health staff will help you reduce the cost of treatment in Germany and take care of all your travel arrangements.

 

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

 

Sources:

MedlinePlus

Medscape

Cochrane Rehabilitation




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