University of Oulu

Kosola, Jussi MD, PhD*; Maffulli, Nicola MD, MS, PhD, FRCP, FRCS(Orth)†,‡,§; Sinikumpu, Juha-Jaakko MD, PhD¶; Pánics, Gergely MD, PhD║; Niemi, Pekka MD, PhD*; Orava, Sakari MD, PhD*; Lempainen, Lasse MD, PhD*. Calcaneal Bone Bruise After Surgery for Insertional Achilles Tendinopathy. Clinical Journal of Sport Medicine 32(1):p e30-e34, January 2022. | DOI: 10.1097/JSM.0000000000000868

Calcaneal bone bruise after surgery for insertional Achilles tendinopathy

Saved in:
Author: Kosola, Jussi1; Maffulli, Nicola2,3,4; Sinikumpu, Juha-Jaakko5;
Organizations: 1Sports Trauma Research Unit, Hospital Mehiläinen NEO, Turku, Finland
2Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Surgery and Dentistry, Salerno, Italy
3Centre for Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom
4School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, United Kingdom
5Department of Children and Adolescents, PEDEGO Unit and MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Department of Traumatology Uzsoki Hospital, Department of Orthopedics & Traumatology, Semmelweis University, Budapest, Hungary
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
Persistent link:
Language: English
Published: Wolters Kluwer, 2022
Publish Date: 2023-05-24


Objectives: Excision of the posterosuperior corner of the calcaneus (EPCC) is routinely undertaken in athletes after failure of conservative management of insertional Achilles tendinopathy. Some patients can experience sharp calcaneal pain during postoperative rehabilitation, a sign of a calcaneal bone bruise (CBB).

Design: Case series, level of evidence IV.

Setting: University teaching hospital.

Patients: This study reports 8 patients who developed postoperative CBB after having started impact training too early.

Intervention: Patients in whom a diagnosis of CBB had been formulated were followed to return-to-play and resolution of bone edema by MRI.

Main Outcome Measures: Detection of CBB after EPCC.

Results: After routine EPCC for insertional Achilles tendinopathy, 8 patients presented with sharp pain for a mean 7.1 weeks (median 6 weeks, range 5‐11 weeks) before clinical suspicion of CBB. At that stage, MRI showed clear evidence of a bone bruise, with a diagnosis of CBB formulated at an average of 10.8 postoperative weeks (range 6‐16 weeks). Calcaneal bone bruise resolved with modified symptom-free loading. Patients returned to play at average on 5.6 months (range 2‐9 months) after the diagnosis of postoperative CBB.

Conclusions: We describe 8 athletes who developed painful CBB following routine EPCC for insertional Achilles tendinopathy after having increased their level of activities too soon after the index procedure. In these patients, the diagnosis of postoperative CBB can be formulated by MRI and more cautious rehabilitation implemented.

see all

Series: Clinical journal of sport medicine
ISSN: 1050-642X
ISSN-E: 1536-3724
ISSN-L: 1050-642X
Volume: 32
Issue: 1
Pages: e30 - e34
DOI: 10.1097/jsm.0000000000000868
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
315 Sport and fitness sciences
Copyright information: © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. This is a non-final version of an article published in final form in Kosola, Jussi MD, PhD; Maffulli, Nicola MD, MS, PhD, FRCP, FRCS(Orth); Sinikumpu, Juha-Jaakko MD, PhD; Pánics, Gergely MD, PhD; Niemi, Pekka MD, PhD; Orava, Sakari MD, PhD; Lempainen, Lasse MD, PhD. Calcaneal Bone Bruise After Surgery for Insertional Achilles Tendinopathy. Clinical Journal of Sport Medicine 32(1):p e30-e34, January 2022. | DOI: 10.1097/JSM.0000000000000868.