Soft Tissue

A. Achilles Tendon Pathology

Achilles Tendon Ruptures (Acute)

Clinical diagnosis (Thompson test, Palpation Gap). Compare non-operative protocols (functional bracing) vs. operative repair (open vs. percutaneous/minimally invasive techniques). Understand risks of sural nerve injury and wound healing complications.

Achilles Tendon Ruptures (Delayed/Chronic)

Evaluate chronic ruptures with gap analysis. Master reconstruction techniques including V-Y advancement, turn-down flaps, and Flexor Hallucis Longus (FHL) tendon transfer to augment repair.

Achilles Tendinosis (Non-insertional)

Pathophysiology (neovascularization, fiber disorganization). Detail non-operative care (PT, eccentric strengthening, bracing). Surgical treatment: debridement and excision of the central core of the tendon.

Achilles Tendinosis (Insertional)

Understand association with Haglund’s deformity and retrocalcaneal bursitis. Surgical management: resection of the calcaneal prominence, bursectomy, and potential debridement of the Achilles insertion, requiring re-attachment.

B. Other Hindfoot and Ankle Tendons (PTT, Peroneals)

Posterior Tibial Tendon (PTT)

Staging of PTT Dysfunction (Johnson & Strom). Non-operative management (Arizona Brace). Surgical principles for Adult-Acquired Flatfoot Deformity (AAFD): PTT repair/grafting, FDL transfer, calcaneal osteotomy (medializing), and spring ligament repair.

Peroneal Tendons

Management of tears, tendinosis, and subluxation/dislocation. Surgical repair techniques: tubularization, tenodesis, and reconstruction of the superior peroneal retinaculum (SPR) with or without groove deepening.