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What Is Brisement?

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 a tendon. While most commonly used for the Achilles tendon, brisement can be performed in any tendon of the foot and ankle.

Diagnosis

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.

Treatment

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.

Recovery

After the procedure, patients typically are able to walk immediately with minimal pain. 

Risks and Complications

There is a low risk for potential injection site pain, bleeding, and infection. There is also a very low risk of tendon damage.

FAQs

Is cortisone ever added to the injection solution?
The use of cortisone is associated with an increased risk of rupture of the Achilles tendon, therefore, steroid injections are not recommended in this area.

The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.