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The response to the question below was authored by Marc Mitnick DPM

heel pain after Achilles tendon surgery

by sue
(visalia ca)

On March 3, 2014 surgery was performed on the right foot to remove two large (one almost an inch & the other 1/2") bone spurs growing directly out of the back of the heel and entangled in achilles tendon. The tendon was disconnected & the spurs removed with the tendon reconnected. The patient was extremely good about bearing no weight on the foot as directed by surgeon. Patient has one spot on the inside of the ankle near the bottom of the foot about the size of a quarter that remains painful and the foot is still swelling. The patient has been receiving PT for eight weeks with no good results and PT suggesting an MRI but surgeon said the MRI would not work as there are bolts and nuts in the ankle. X-rays have not revealed the problem. The surgeon now thinks it is possible a stitch used for the top of the incision (the type that does not dissolve) broke off inside the heel and that is causing the problem. Meanwhile the patient has been directed to wear the black boot (now four weeks) which he wore for twelve weeks prior after surgery. When ice packs are applied the spot turns white. The foot is noticeably larger than the left foot when swollen after walking on it with or without the boot.

RESPONSE

Hi Sue,

I am only getting your side of the story but it sounds like your surgeon is kind of evading the issue with excuses that do not make much sense to me.

The surgery was performed over six months ago and at this point in time, healing should be well on its way to the point where there may be a twinge of pain every now and then.

When you say the surgeon says a stitch may have broken off on

the top of the incision, I am not sure if you mean one of the non-dissolving sutures holding the skin together or perhaps he put non-dissolving stitches deeper in the incision which is sometimes done to "hold" something in place.

in either event, one broken stitch should not be causing the amount of pain that is being experienced in this case. Secondly, if the suture has actually broken underneath the skin and you have developed what is known as a suture abscess, all the physical therapy in the world is not going to clear it up. A suture abscess, like any abscess has to be drained. It is essentially an infection under the skin and will not clear up with physical therapy.

The fact that the spot in question turns white when exposed to ice suggests possibly some type of vascular compromise to that area, because ice causes blood vessels to constrict, but when there is compromise to begin with, ice will blanch the area.

I also do not understand why your surgeon is so hesitant to order a MRI. If this was my patient, six months down the road, I would be concerned and would want a better evaluation of the surgical site than an x-ray can offer me. With a MRI you have to be careful about metal implanted in the area, but most orthopedic implants are safe with a MRI and yes, there is a chance the implanted metal may distort the MRI image, but most achilles surgery done today is done with clasps or staples which is less hardware than "nuts and bolts" as your surgeon describes.

This is about all I can offer from this side of internet. I think the best advice I could offer would be to get a second opinion from another surgeon in your area.

Marc Mitnick DPM
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Sep 22, 2014
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Six months and still having pain in heal.
by: Sue

Thank you so much for your response to my husband's situation. To clarify the stitch the doctor referred to was a stitch to hold closed the wound and he is saying it is possible part of the stitch broke under the skin and is causing the problem. It is not one that dissolves. Yes I will show this to my husband immediately and make an appointment for a second opinion.

Hi Sue,
I have been doing foot surgery for 35 years and I have never seen such a situation. Yes, many times part of a suture is left in the wound, but it does not cause the amount of pain your husband is having. Even if this situation exists, as I said earlier, physical therapy and a boot is not going to resolve it.

Marc Mitnick DPM

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Columbia University Department of Rehabilitation

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Illinois Bone and Joint Institute

Mount Sinai Hospital

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heel pain after Achilles tendon surgery

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