Foot and Ankle Endoscopy

Achilles endoscopic surgery is a minimally invasive option that has been described to manage different pathologies related to the Achilles tendon, including non-insertional Achilles tendinopathy, Haglund’s deformity, equinus contracture, even Achilles ruptures. Tendoscopic surgery minimizes the risk for some of the complications associated with open surgery, such as scarring, perioperative pain, and wound complications, and it may also provide a faster recovery. No clear guidelines have been established related to the efficacy of the endoscopic technique in Achilles tendinopathy. Only small series have been reported, and over different populations with varying degrees of tendinopathic compromise, which makes it even harder to give recommendations on its use. The indication for tendinoscopy in non-insertional Achilles tendinopathy is becoming more accepted, with good results and good outcomes consistently reported with few or no complications. As already said, these studies are limited by their low number of patients and retrospective nature, and therefore on a review of the literature performed in 2014 by Cychosz et al., a grade C recommendation (for intervention) to the Achilles tendoscopy was given. No evidence-based recommendation has been given to tendinoscopy for insertional Achilles tendinopathy, and more information and well-designed studies are needed to further elucidate the role of impingement against the calcaneus. The authors believe that this is a promising area for further research where limited surgical approaches will have an important role in the future.