Brisement

What is brisement?

Brisement is the injection of fluid into the space between the Achilles tendon and its sheath.
 

What are the goals of brisement?

This procedure is performed to break up scar tissue and stimulate healing of a tendon. While commonly used for the Achilles tendon, brisement can be performed in any tendons of the foot and ankle.
 

What signs indicate brisement is needed?

Brisement may be considered for patients with painful inflammation of the Achilles paratenon when it has not responded to conservative treatment. In some cases, there may be crackling about the tendon with activity.
 

When should I avoid brisement?

Brisement is unlikely to work in advanced cases with associated degeneration and thickening of the Achilles tendon. It should not be done if you have an infection in the area.
 

General Details of Procedure

This is an outpatient procedure that is performed in your orthopaedic surgeon’s office. Ultrasound may be used to help place the injection.
 

Specific Technique

The patient is asked to lie on their stomach. The skin around the Achilles tendon and calf is cleaned. A needle is inserted into the space between the Achilles tendon and sheath. Then a small amount of fluid is injected. An adhesive bandage is applied to the injection site.
 

What happens after brisement?

After the procedure, you should be able to walk. The pain is minimal.  It does not require a hospital admission. Additional later injections may be necessary.
 

Potential Complications

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

Frequently Asked Questions

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

Additional Resources

Achilles Tendinitis

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 an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.