Brisement is the injection of fluid into the space between a tendon and its lining, or sheath. This procedure breaks up scar tissue and stimulates healing of the tendon. While most commonly used for the Achilles tendon, brisement can be performed on any tendon of the foot and ankle.
Your foot and ankle orthopaedic surgeon may recommend brisement if your Achilles paratenon (the layer of tissue that wraps around the fibers of the tendon) is painful and swollen and has not responded to conservative treatment. In some cases, there may be crackling around the tendon with activity.
Brisement is unlikely to work in advanced cases when the actual Achilles tendon fibers have degenerated or thickened. The procedure should not be done if you have an infection.
This is an outpatient procedure that is typically performed in the office. Your surgeon may use ultrasound to assist in proper placement.
While you lie on your stomach, your surgeon will clean the skin around your Achilles tendon and calf. The surgeon will insert a needle into the space between the Achilles tendon and sheath and inject a small amount of fluid. An adhesive bandage is applied to the injection site.
After the procedure, patients typically are able to walk immediately with minimal pain.
There is a low risk for potential injection site pain, bleeding, and infection. There is also a very low risk of tendon damage.
Is cortisone ever added to the injection solution?
The use of cortisone is associated with an increased risk of rupturing (tearing) the Achilles tendon. Therefore, steroid injections are not recommended in this area.
Original article by Eric Tan, MD
Last reviewed by Patrick Maloney, MD, 2018
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