Insertional Achilles Tendinitis and Haglund's Deformity

NewsBot · Jun 2, 2012

Members do not see these Ads. Sign Up.
Insertional Achilles Tendinitis and Haglund’s Deformity
Steve Kang; David B. Thordarson; Timothy P. Charlton
Foot & Ankle International June 2012 (Vol. 33 #6) June 1, 2012

Haglund’s deformity is an enlargement of the posterosuperior prominence
of the calcaneus, which is frequently associated with insertional
Achilles tendinitis. To our knowledge, no study has been done
successfully correlating the characteristics of a Haglund’s deformity
with insertional Achilles tendinitis. The purpose of our study was to
analyze the characteristics of a Haglund’s deformity in patients with
and without insertional Achilles tendinitis to see if there was a
correlation.

Methods: The study was a retrospective radiographic review
of a single surgeon’s patients with insertional Achilles tendinitis
from 2005 to 2008. Our study population consisted of 44 patients, 48
heels (22 male, 22 female) with insertional Achilles tendinitis, with a
mean age of 52 (range, 23 to 79) years. Our control population
consisted of 50 patients (25 males, 25 females) and 50 heels without
insertional Achilles tendinitis with a mean age of 55.6 (range, 18 to
89) years. We introduced two new measurements of the Haglund’s
deformity in this study: the Haglund’s deformity height and peak angle.
A standing lateral foot or ankle radiograph was analyzed for each
patient and the following measurements were made: Haglund deformity
height and peak angle; Bohler’s angle; Fowler-Philip angle; and
parallel pitch sign. We also looked for the presence of calcification
in the study group and the length and width of the calcification.
Unpaired t-test was used to analyze the measurements between the
groups. Ten patients’ radiographs were re-measured and correlation
coefficients were obtained to assess the reliability of the measuring
techniques.

Results: For the insertional Achilles tendinitis group, the
mean Haglund’s deformity height was 9.6 (range, 5.3 to 15.3) mm and the
mean Haglund’s deformity peak angle was 105 (range, 87 to 123) degrees.
Calcification was present in 35 of 48 or (73%) of patients with a mean
length of 13.3 (range, 3.2 to 41.9) mm and mean width of 4.5 (range,
1.0 to 10.4) mm. In the control group, the mean Haglund’s deformity
height was 9.0 (range, 5.2 to 12.1) mm and the peak angle was 105
(range, 91 to 124) degrees. Bohler’s angle and Fowler-Philip angle were
also similar between the groups and the positive parallel pitch sign
was actually more prevalent in the control group (60% versus 41.7%).
None of the differences in measurements between the groups achieved
statistical significance.

Conclusion: A Haglund’s deformity was not
indicative of insertional Achilles tendinitis and was present in
asymptomatic patients. Also, a majority of the insertional Achilles
tendinitis patients had calcification at the tendon insertion. We
believe it is possible removing the Haglund’s deformity may not be
necessary in the operative treatment of insertional Achilles
tendinitis.
Click to expand...

Admin2 · Jun 2, 2012

Re: Insertional Achilles Tendinitis and Haglund’s Deformity

Related threads:
Other threads tagged with Haglunds deformity
Other threads tagged with achilles tendon

NewsBot · Feb 22, 2014

Re: Insertional Achilles Tendinitis and Haglund’s Deformity

Radiographic, Clinical, and Magnetic Resonance Imaging Analysis of Insertional Achilles Tendinopathy
Priya Ponnapula Sundararajan, Troy Scott Wilde
The Journal of Foot and Ankle Surgery; Volume 53, Issue 2, March–April 2014, Pages 147–151

The surgical correction of insertional Achilles tendinopathy (IAT) repair typically involves tendon debridement, osteophyte removal, lengthening of the gastroc-soleus complex, and resection of the posterior superior calcaneal eminence. Limited evidence has supported decompression of the superior calcaneal prominence, because this step has had a pronounced association with the surgical treatment of Haglund's syndrome. To appreciate the posterior calcaneal abnormality, 20 lateral weightbearing radiographs of asymptomatic patients were compared with 20 lateral weightbearing radiographs of patients with symptomatic IAT. The radiographs were evaluated for the calcaneal inclination angle, Fowler–Philip angle, total angle, parallel pitch lines, Chauveaux–Liet angle, and the presence or absence of retrocalcaneal enthesiophytes. Patients with IAT were also examined clinically and using magnetic resonance imaging to determine the incidence of Haglund's syndrome within the symptomatic population. A comparison of the radiographs revealed minimal differences in calcaneal morphology between the 2 populations. Of the analyzed variables, only an elevated Chauveaux–Liet angle and the presence of a retrocalcaneal enthesiophytes were characteristic of patients with IAT. The results of the present study have confirmed the absence of morphologic calcaneal variation and the presence of altered calcaneal angulations in symptomatic patients. Both the clinical examination and magnetic resonance imaging revealed a 25% frequency of Haglund's syndrome within the IAT population. Because these 2 diagnosis are clinically and radiographically divergent, their surgical interventions warrant distinct goals using separate methods. By understanding the abnormality, the surgeon can taper the correction precisely and specifically toward patients with IAT.
Click to expand...

NewsBot · Aug 25, 2015

Insertional Achilles tendinopathy is associated with arthritic changes of the posterior calcaneal cartilage: a retrospective study
Ezequiel Palmanovich, Yael Oshri, Yaron S. Brin, Evgeny Edelshtein, Meir Nyska and Iftach Hetsroni
Journal of Foot and Ankle Research 2015, 8:44 doi:10.1186/s13047-015-0103-8

Background
To characterize the histological changes within the posterior calcaneal cartilage in patients with insertional Achilles tendinopathy (IAT) and test the relationships between severity of the histological changes and level of functional impairment.

Methods
Sixteen posterior calcaneal wall specimens of patients with IAT who had posterior calcaneal ostectomy were investigated. Hematoxylin-eosin stain, Toluidine-blue stain, Polarized light microscopy, and Masson Trichrome stain were used to characterize histological changes. Changes within the posterior calcaneal wall cartilage were graded according to Osteoarthritis Research Society International (OARSI) criteria. Functional scores were completed at the time of surgery according to the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score.

Results
Mean age of patients was 48.9 years. Histological findings within the posterior calcaneal wall cartilage specimens were consistent with arthritic changes. OARSI grading indicated Grade 2 changes in one specimen, mean AOFAS score 60; Grade 3 changes in three specimens, AOFAS score 73.7 ? 2.5; Grade 4 changes in four specimens, AOFAS score 44 ? 21.4; Grade 5 changes in eight specimens, AOFAS score 48 ? 9.9. Higher OARSI grades were correlated with lower AOFAS scores (rho = −0.65, p < 0.01).

Conclusions
Degenerative arthritic changes of the posterior calcaneal wall cartilage characterize patients with IAT and the severity of such changes is directly correlated to the degree of functional impairment.
Click to expand...

NewsBot · Jun 24, 2021

A novel technique of minimally invasive calcaneal osteotomy for intractable insertional Achilles tendinopathy associated with Haglund deformity
Jun YoungChoiJin SooSuh
Foot and Ankle Surgery; 15 June 2021

Background
To date, minimally invasive surgery (MIS) involving calcaneal osteotomy for Haglund deformity associated with intractable insertional Achilles tendinopathy has not been reported. This study presents the radiographic and clinical outcomes of our novel MIS-dorsal closing wedge calcaneal osteotomy (DCWCO) technique compared to open Haglund resection. We hypothesized that earlier clinical improvement after MIS-DCWCO could be achieved by leaving the Achilles tendon insertion site untouched.

Methods
We retrospectively reviewed and compared the clinical and radiographic parameters of patients who underwent MIS-DCWCO (11 cases) or open Haglund resection (14 cases) between January 2012 and June 2019. The minimum duration of follow-up for inclusion was 18 months. We measured the calcaneal pitch, Meary’s, Fowler-Philip, and Böhler’s angles. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores measured preoperatively and at 3, 6, 9, 12, and ≥18 months, postoperatively.

Results
In both groups, the Meary’s and calcaneal pitch angles did not change significantly, whereas the Fowler-Philip and Böhler’s angles were significantly changed postoperatively. Significant improvements in VAS and VISA-A scores were observed in both groups (P < .001). The extent of correction of the four radiographic and two clinical parameters were not significantly different between the two groups. However, VAS and VISA-A scores at postoperative 6 months were significantly different, whereas these parameters were not significantly different at all other time points.

Conclusion
Both techniques provided similar postoperative clinical and radiographic improvement. However, MIS-DCWCO achieved earlier clinical improvement than open Haglund resection.
Click to expand...

NewsBot · Jul 15, 2021

Return to Play After Open Calcaneoplasty for Insertional Achilles Tendinopathy With Haglund Deformity in Competitive Professional Athletes
Kyung Tai Lee, MD, PhD, Jegal Hyuk, MD, Sung Jae Kim, MD, PhD
Orthopaedic Journal of Sports Medicine June 9, 2021

Background:
Surgical treatment of insertional Achilles tendinopathy with Haglund deformity in highly competitive professional athletes has not been previously investigated.

Purpose:
To assess clinical outcomes, including return to play (RTP), after surgical treatment of insertional Achilles tendinopathy in professional athletes.

Study Design:
Case-control study; Level of evidence, 3.

Methods:
This retrospective study included 20 professional athletes who were surgically treated for insertional Achilles tendinopathy and had at least 2 years of follow-up. An open longitudinal lateral approach was used for the operation, without violation of the Achilles tendon. Outcome evaluation included American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, subjective patient satisfaction, mean time of return to competition (RTC), and rate of RTP. We defined RTC as return to an official match for at least 1 minute and RTP rate as the percentage of patients who were able to participate in at least 2 full seasons. A subgroup analysis was performed to compare the RTP and no-RTP groups.

Results:
The AOFAS score improved significantly from preoperatively to the final follow-up (from 65.1 to 88.4; P < .001), and 75% of the patients reported good to excellent satisfaction. The mean time of RTC was 7.45 months (range, 4-18 months), and the rate of RTP was 60%. The RTP group had a significantly lower mean body mass index than did the no-RTP group (22.03 vs 23.86, respectively; P = .005) and faster mean RTC (5.0 vs 11.1 months, respectively; P < .001).

Conclusion:
Open calcaneoplasty for surgical treatment of insertional Achilles tendinopathy with Haglund deformity in highly competitive professional athletes should be approached cautiously. Our patients had a 7.5-month recovery period before return to their first official match, and only 60% of the patients returned to their sports activity and participated in at least 2 full seasons. Lower body mass index and a faster RTC after surgery were related to longer functional maintenance.
Click to expand...

NewsBot · Jan 3, 2022

Haglund's Deformity as a Cause of Acute Achilles Tendon Rupture: A Case Report
Saad Madi, Bernd Hillrichs
J Foot Ankle Surg. 2021 Mar 21;S1067-2516(21)00089-2

Achilles tendon rupture is a common problem affecting both high level and casual athletes. Haglund´s deformity is an abnormality of the postero-superior part of the calcaneus, which often leads to retro-calcaneal bursitis as well as thickening and inflammation of the calcaneal tendon, a combination of pathologies known as Haglund's syndrome. We report a rare case of a relapse Achilles tendon rupture in a 39-year-old professional handball player with a pronounced painful Haglund´s deformity treated with tendon debridement and reattachment using the Arthrex Speedbridge® system. This case report illustrates a rarely described operative and post-operative management of this unusual combination of Achilles tendon rupture and Haglund´s deformity.
Click to expand...

NewsBot · Jul 13, 2022

Haglund's Deformity as a Cause of Acute Achilles Tendon Rupture: A Case Report
Saad Madi, MD et al
JFAS: March 20, 2021

Achilles tendon rupture is a common problem affecting both high level and casual athletes. Haglund´s deformity is an abnormality of the postero-superior part of the calcaneus, which often leads to retro-calcaneal bursitis as well as thickening and inflammation of the calcaneal tendon, a combination of pathologies known as Haglund's syndrome. We report a rare case of a relapse Achilles tendon rupture in a 39-year-old professional handball player with a pronounced painful Haglund´s deformity treated with tendon debridement and reattachment using the Arthrex Speedbridge® system. This case report illustrates a rarely described operative and post-operative management of this unusual combination of Achilles tendon rupture and Haglund´s deformity.
Click to expand...

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Insertional Achilles Tendinopathy

Outcomes for Insertional Achilles Tendinopathy

Subcutaneous bursa is important in insertional achilles tendinopathy

Cholesterol level in non-insertional Achilles tendonopathy

Treatment options for Achilles Insertional Calcific Tendinopathy

Is Apoptosis the Cause of Noninsertional Achilles Tendinopathy

Prediction of the success for treatment of insertional achilles tendinosis

Share This Page