Surgery for Haglunds / Retrocalcaneal Bursitis

NewsBot · Jul 27, 2023

Surgical Treatment of Haglund's Disease: About 9 Cases
Abakka M et al
Source

Haglund's disease is a rare disease of the hindfoot, linked to a morphological anomaly of the calcaneus posterosuperior tuberosity, causing pre and retro-Achilles bursitis and insertional tendinopathy. The purpose of our work is to
analyze the functional results according to long-term resections of the posterosuperior tuberosity of the calcaneus,
specifying the radio-clinical and therapeutic aspects of this pathology. Our study is a retrospective study of nine cases
of Haglund's disease operated in the Department of Orthopedic and Traumatology at the Ibn Sina hospital in Rabat,
between 2019 and 2023, correlated with a simple literature review. The average age of our patients was 41 years old
with a male predominance. All our patients showed painful retrocalcaneal swelling. The diagnosis was confirmed by
radiological explorations (standard radiography and MRI). After failure of medical treatment, surgery consisted in an
open resection of the postero-superior tuberosity of the calcaneus. The evolution was favorable in 92% of cases.
Complications were rare. Haglund's disease is a pathology often underestimated, we must think about it before all
Achilles insertion tendinopathy. Resection of the tuberosity is a simple technique, with undeniable effectiveness, and
which is considered the best treatment.
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NewsBot · Nov 14, 2023

Platelet rich plasma (PRP) in the surgical treatment of Haglund's syndrome: the use of PRP membranes as an intra-operative local adjuvant
Giuseppe Restuccia et al\
Med Glas (Zenica). 2024 Feb 1;21(1)

Aim Haglund's syndrome may be responsible for chronic pain in the ankle and hindfoot. Although numerous therapeutic approaches have been described in the literature, to this date no consensus over a surgical treatment has been established. We report our experience in the treatment of Haglund's syndrome and pre-insertional calcifications of the Achilles tendon using an open surgical approach and platelet rich plasma (PRP) membranes as a local adjuvant. Methods The study retrospectively evaluated patients with Haglund syndrome treated with a direct posterior access, Achilles tendon split, bursectomy, resection of the heel deformity and topical administration of PRP membranes. After surgery, a standardized rehabilitation protocol was performed. The preoperative and postoperative functionalities of the foot and ankle were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score. Intraoperative and postoperative complications were recorded. Results Twenty consecutive patients were included. The mean follow-up was 23 months. No patient had major intraoperative or postoperative complications. After the surgery, the mean AOFAS score increased from 44.1 to 92.0, resulting in a statistically significant increase in patient functionality after the treatment (p=0.001). Conclusion Our results suggest that an open surgical approach consisting of a combination of bursectomy, resection of the calcaneal deformity, and topical administration of PRP membranes may be effective for the treatment of Haglund's disease.
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NewsBot · Nov 14, 2023

Effect of sequential burr passes on osteotomy magnitude and calcaneal morphology in minimally invasive Zadek osteotomy
Bedri Karaismailoglu et al
Foot Ankle Surg. 2023 Oct 30

Purpose: This study aimed to evaluate the impact of each burr pass on degree of correction, gap size and calcaneal morphology in MIS Zadek osteotomy.

Methods: MIS Zadek osteotomy was performed on ten cadaveric specimens using a 3.1 mm Shannon burr. After each burr pass, the osteotomy gap was manually closed, and the subsequent burr passes were carried out with the foot held in dorsiflexion, which was repeated five times. Lateral X-rays were taken before and after each burr pass. Two independent reviewers measured the dorsal calcaneal length after each burr passage, as well as changes in several calcaneal parameters including X/Y ratio, Fowler Philip angle, and Böhler angle.

Results: The average decrease in dorsal calcaneal cortical length with each burr pass was as follows: 2.6 ± 0.9 mm at the 1st pass, 2.4 ± 1 mm at the 2nd pass, 2 ± 1 mm at the 3rd pass, 1.6 ± 1 mm at the 4th pass, and 1.4 ± 0.7 mm at the 5th pass. The Fowler Philip and Böhler angles consistently decreased while the X/Y ratio consistently increased following each consecutive burr pass. Interobserver reliability analysis demonstrated good agreement for all parameters.

Conclusion: The results revealed the trends of length and anatomical changes in the calcaneus with each burr pass. On average, a dorsal wedge resection of 10 mm was achieved after 5 burr passes. This data can aid surgeons in determining the optimal number of burr passes required for a particular amount of resection, ensuring the attainment of the desired patient-specific surgical outcome.
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NewsBot · Jan 4, 2024

Landmarks for a Minimally Invasive Approach for Haglund's Deformity: A Cadaveric Study
Sara Mateen et al
Foot Ankle Spec. 2023 Nov 29

Introduction: Haglund's deformity is a posterosuperior calcaneal prominence often associated with a painful bursa and insertional Achilles tendinopathy. Endoscopic debridement has been previously described; however, the aim of this cadaveric study is to describe landmarks of a minimally invasive surgical (MIS) approach to Haglund's deformity.

Methods: Twelve specimens were dissected to identify medial and lateral portals for minimally invasive burr placement and anchor placement. A standard ruler was used to measure the distance in millimeters from the medial and lateral neurovascular structures in relation to medial and lateral portals. A separate 7-cm longitudinal incision posterior to the lateral malleolus and a separate 7-cm longitudinal incision posterior to the medial malleolus were made to identify at-risk neurovascular structures.

Results: The average distance from the sural nerve to the lateral portal was 25.7 mm (23-26). The mean distance from the lateral calcaneal branch of the sural nerve to lateral portal was 11.4 mm (10-12). The mean distance from the tibial nerve to the medial portal was 35.3 mm (35-36). Both the medial and lateral incisions were 9.3 mm from the calcaneal tuberosity.

Conclusion: The results indicate that the MIS approach to Haglund's deformity resection can be performed reliably without neurovascular compromise.
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NewsBot · Apr 17, 2024

Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis–Related Heel Pain
Bernd Friesenbichler, et al
Source

Background:
Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists.
Methods:
Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed.
Results:
Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as “helped” or “helped a lot” (Global Treatment Outcome).
Conclusion:
In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up.
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NewsBot · Apr 17, 2024

Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund's Deformity: A Systematic Review
Yianni Bakaes et al
Foot Ankle Orthop. 2024 Apr 12;9(2)

Background: Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines.

Methods: A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies.

Results: A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO.

Conclusion: Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.
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NewsBot · Apr 22, 2024

Haglund resection versus Haglund non-resection for calcific insertional Achilles tendinopathy with Haglund deformity: A retrospective study
Lin Ma et al
Foot Ankle Surg. 2024 Mar 13

Background: Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity.

Methods: A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively.

Results: Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018).

Conclusion: Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformit
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NewsBot · Apr 30, 2024

Minimally Invasive Approaches to Haglund’s Deformity and Insertional Achilles Tendinopathy: A Contemporary Review
SarahRose Hall et al
Source

Introduction
Minimally invasive surgical (MIS) procedures are becoming increasingly popular in foot and ankle surgery. Several benefits of MIS procedures have been reported in the literature including decreased postoperative pain, shorter recovery times, and lower need for postoperative narcotics.10,11,33,53,71,72 Specifically regarding Haglund deformity (HD) and insertional Achilles tendinopathy (IAT), MIS techniques have been increasingly used over the last decade.
Traditional open procedures for HD and IAT have relatively good outcomes; however, longer recoveries combined with complications such as wound issues and infections have resulted in the expansion of MIS approaches to treat these pathologies. Although the first generation of MIS techniques involved endoscopic surgery,5,11,13-15,17,18,24,27,33,35,50,53-55,70,73,74 percutaneous approaches are now gaining momentum. The current work reviews these techniques including endoscopic calcaneoplasty (Haglund resection), percutaneous Haglund resection, and percutaneous Zadek (dorsal closing wedge) calcaneal osteotomy.
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NewsBot · May 3, 2024

Endoscopic Calcaneoplasty With Bony Debridement and Radiofrequency
Jun Rui Don Koh et al
Arthrosc Tech. 2024 Feb 1;13(4):102912

Haglund's deformity refers to the enlargement of the posterosuperior tuberosity of the calcaneus, which can cause debilitating posterior heel pain and swelling. Calcaneoplasty is indicated for the treatment of Haglund's deformity following a failure of conservative treatment. Endoscopic calcaneoplasty confers a few advantages over open surgery and has been growing in popularity as the preferred technique. This Technical Note presents an endoscopic calcaneoplasty technique with bone debridement followed by treatment with a Topaz radiofrequency device, with the patient in a supine position.
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NewsBot · May 10, 2024

Comparison of Lateral and Central Achilles Tendon-Splitting Approaches in the Treatment of Haglund Deformity
Enver Kilic et al
Foot Ankle Int. 2024 May 9

Background: This study aimed to compare the complications and outcomes of lateral and central Achilles tendon-splitting approaches for the treatment of Haglund syndrome.

Methods: Patients who underwent surgery for Haglund syndrome between June 2012 and June 2022 were included in the study. Patients undergoing lateral approach surgery were included in group 1, whereas patients undergoing central Achilles tendon-splitting approach surgery were included in group 2. Surgical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale, visual analog pain scale (VAS), and Victorian Institute of Sport Assessment-Achilles (VISAA) scores. In addition, preoperative and final follow-up scores were compared.

Results: The study included 66 patients: 32 (14 females, 18 males) underwent surgery using the lateral approach in group 1, whereas in group 2, 34 patients (18 females, 16 males) underwent surgery using the central Achilles tendon-splitting approach. There was a significant statistical difference in the AOFAS, VISAA, and VAS scores between preoperative and final follow-up for both group 1 and group 2 (P < .001, P < .001, P < .001, P < .001, respectively). Group 1 had a small (0.76) relative increase in VAS score compared with group 2 (P = .033). There was no significant difference between the complication rates of group 1 and group 2.

Conclusion: In our study, we found the lateral approach and central Achilles tendon-splitting approaches to be safe and effective in the surgical treatment of Haglund syndrome without clinically meaningful differences in outcomes or complication rates.
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NewsBot · Jun 14, 2024

Heel Pain Management in Haglund’s Deformity Targeting Sural Nerve Branches under Ultrasound Guidance: Case Report
Source

Introduction: Haglund’s deformity is an abnormality of the bone and soft tissue of the foot, also known as retrocalcaneal exostosis, Mulholland deformity, and “pump bump”. The etiology is not well known. Probable causes include a tight Achilles tendon, a high arch of the foot, and hereditary. The clinical features consist of pain at the posterior aspect of the heel which is predominantly present when the patient begins to walk after a period of rest or inactivity.

Case Report: We report a case of a 60-year-old teacher with left heel pain for 3 years, unable to stand or walk for more than 15 min due to pain. We diagnosed him as a case of Haglund’s deformity and treated him with ultrasound-guided injections targeting the superficial branches of the sural nerve. This case report illustrates a rarely described modality for the management of heel pain due to Haglund’s deformity. Targeting superficial branches of the Sural nerve under ultrasound guidance can act as a superior treatment modality for the management of heel pain due to Haglund’s deformity.

Conclusion: Haglund's deformity is a cause of pain in the hindfoot that should be taken into account in the differential diagnosis of any patient presenting with heel pain. Ultrasonography has proved to be an important cost-effective tool in the diagnosis and management of various ankle pathologies like Haglund’s deformity, thereby reducing the sole dependence on surgical management. Targeting the superficial (cutaneous) branches of the sural nerve can give satisfactory long-term relief of heel pain in patients with Haglund deformity.
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NewsBot · Jun 25, 2024

Haglund resection versus Haglund non-resection for calcific insertional Achilles tendinopathy with Haglund deformity: A retrospective study
Lin Ma et al
Foot and Ankle Surgery Volume 30, Issue 5, July 2024, Pages 432-439

Background
Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity.

Methods
A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment–Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively.

Results
Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018).

Conclusion
Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformity.
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NewsBot · Jul 28, 2024

Bi-portal Endoscopic Calcaneoplasty for Haglund's Deformity
Abhishek Saini et al
Cureus. 2024 Jun 18;16(6):e62658

Introduction Haglund's deformity is an abnormal bony postero-superior calcaneal prominence which causes the posterior heel pain. Surgery is the choice of treatment after failed conservative management. Both open and endoscopic techniques are used to treat this condition. In this article, we discuss endoscopic calcaneoplasty for the management of such cases. Methods All included patients underwent bi-portal endoscopic calcaneoplasty. Clinical outcomes were assessed by using the visual analog scale (VAS) score and the American Orthopaedic Foot and Ankle Society (AOFAS) score. The radiological outcome was assessed by a change in the Fowler-Philip angle (FPA). All patients were followed at one month, three months, and six months postoperatively. Results A total of 22 patients were included in this prospective study. Patients were followed up to six months postoperatively. The mean VAS score was 6.32 ± 0.65 which was significantly reduced to 0.91 ± 0.68 (p < 0.001) at six months. Similarly, AOFAS Score was improved to 90.01 ± 2.67 (p < 0.001) from 64.36 ± 7.07 preoperatively. The mean Fowler Philip Angle was reduced from 72.45° ± 3.74° to 65.77° ± 2.25° at six months (p < 0.001). Conclusion Bi-portal endoscopic calcaneoplasty significantly improves clinical outcomes in Haglund's deformity. Compared to open procedures, bi-portal endoscopic calcaneoplasty offers several advantages, including shorter recovery times, smaller incisions, and better clinical results for Haglund's deformity.
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NewsBot · Aug 5, 2024

Endoscopic Calcaneoplasty in Haglund Disease: Surgical Technique, Clinical and Subjective Outcomes
Guillermo Cardone et al
Foot Ankle Int. 2024 Aug 2

Background: During the last decade, arthroscopic procedures have been replacing open techniques in Haglund disease treatment because of their considerable advantages. Endoscopic calcaneoplasty is a technique that allows resection of posterosuperior calcaneal exostosis and retrocalcaneal bursitis. The objective of this article was to describe this technique and report its clinical and subjective outcome.

Methods: A retrospective study was performed of consecutive patients undergoing endoscopic Haglund resection surgery between July 2014 and March 2020 at a single academic institution. All patients were surveyed in person about the level of pain (visual analog scale), its location (central, lateral, medial or diffuse), its relation with rest, or physical activity. Clinical evaluation was assessed using the hindfoot scale designed by the American Orthopedics Foot & Ankle Society AOFAS.

Results: In this study, 14 endoscopic calcaneoplasties were performed in 14 patients, with an average follow-up of 40 months. The visual analog scale score improved from a preoperative average value of 9.07 to 1.8 after surgery (P > .0001). The AOFAS scale rose from 38.7 before surgery to 94.6 postoperative (P > .0001). Good subjective results were observed in 12 patients (85.7%), and all of them would have surgery again. There were no wound complications or infections. No patient required reoperation.

Conclusion: In this relatively small cohort, we found that endoscopic calcaneoplasty was associated with good clinical and subjective results with few complications.
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NewsBot · Aug 6, 2024

Does FHL Tendon Transfer Alter the Outcome of Haglund Deformity Treatment by Using Debridement and Ostectomy in Patients Older Than 50 Years? A Single-Blinded Randomized Controlled Trial
Amir Sabaghzadeh et al
Foot Ankle Orthop. 2024 Jul 24;9(3)

Background: Chronic Achilles tendinopathy following Haglund disease is a common ankle condition that is difficult to manage. In this study, we will compare the clinical outcomes of debridement and ostectomy with and without FHL tendon transfer in treating Haglund deformity.

Methods: Forty eligible patients aged >50 years who did not respond to conservative treatment were randomly divided into 2 groups for surgical approach: using flexor hallucis longus (FHL) tendon transfer (FHL group) or "standard procedure" (control group). The main surgical treatment included debridement and ostectomy. AOFAS and VISA-A scores were obtained from all patients pre- and postoperatively.

Results: Twenty patients were assigned to each of the 2 groups and were observed for at least 1 year. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scores and the Victorian Institute of Sports Assessment self-administered Achilles (VISA-A) questionnaires scores improved more in the FHL group; however, the average difference in the change in scores did not reach the levels previously reported for minimal clinically important differences. Surgical complications and hallux function were not significantly different between the 2 groups.

Conclusion: We found that FHL tendon transfer may improve the clinical outcome scores of Achilles tendon treatment in patients aged >50 years using debridement and ostectomy. However, tendon transfer increases the time of surgery and creates additional skin incisions, which may cause more short-term wound complications, and the significance of the differences in outcome improvement may not be clinically meaningful.
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NewsBot · Oct 16, 2024

Open Dorsal Closing-Wedge Calcaneal Osteotomy for Haglund Exostosis-Related Heel Pain
Thomas Rutishauser et al
Foot Ankle Int. 2024 Oct 16

Background: Dorsal closing-wedge calcaneal osteotomy (DCWCO) is a treatment option for persistent Haglund exostosis-related heel pain after failed conservative management. In modifying the orientation of the calcaneal tendinous insertion site and reducing mechanical stress, the consequences of DCWCO-associated biomechanical changes on everyday foot function remain unknown.

Methods: This retrospective cohort study analyzed routinely collected clinical data as well as data from our foot and ankle registry. One hundred twenty patients (66 males, 54 females, 17-77 years) who underwent DCWCO from January 2016 to December 2019 were included. Adverse events were collected from the patient files. Foot Function Index (FFI) scores were collected before (baseline) and at 6, 12, and 24 months postsurgery. Radiographic parameters including the Achilles tendon moment arm and X/Y ratio were evaluated from standard preoperative and 6-week postoperative radiographs. Correlations between FFI and biomechanical changes were calculated for men and women separately with the Pearson correlation coefficient and Bonferroni correction.

Results: One intra- and 18 postoperative adverse events were documented. Mean baseline FFI pain decreased from 47.9 ± 17.2 to 12.0 ± 17.5 points at 24 months with an average decrease of -21.8 ± 21.3 points occurring within the first 6 months postsurgery. A similar trend was also seen with the FFI disability score (49.6 ± 20.3 to 12.8 ± 17.6 points). The mean decrease in Achilles tendon moment arm was -8.1 ± 3.8 mm and mean X/Y ratio increased from 2.6 ± 0.3 to 3.8 ± 1.0. There were no significant correlations between the FFI score and radiographic changes.

Conclusion: DCWCO effectively alleviates exostosis-related heel pain and associated disabilities. Improvements can still be expected up to 2 years after surgery. Radiographic changes of the foot and ankle are significant but do not correlate with patient-reported outcome measures.
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NewsBot · Oct 22, 2024

Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis–Related Heel Pain
Bernd Friesenbichler et al
Source

Background:
Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists.
Methods:
Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed.
Results:
Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as “helped” or “helped a lot” (Global Treatment Outcome).
Conclusion:
In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up.
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NewsBot · Oct 28, 2024

Haglund’s Deformity, Retrocalcaneal Bursitis, and Achilles Tendinopathy (Haglund’s Syndrome) Treated with Arthroscopic Calcaneoplasty, Synovectomy and PRP Injection Outcome Score: A Case Report
Handy Haryono and Evan Lim
Source

Introduction:
Haglund’s deformity is an abnormal bony enlargement of posterosuperior part of calcaneus at the attachment of achilles tendon which often leads to retrocalcaneal bursitis and insertional achilles tendinopathy (Haglund’s syndrome) causing back heel pain. Arthroscopic calcaneoplasty, synovectomy and PRP injection should be considered as minimally invasive treatment option with speedy recovery.
Case Report:
A 57 years old woman came with pain and lump at posterior site of left ankle more than right ankle since 6 months before that didn’t respond conservatively. Pain was felt with pressure on left ankle with edema. AOFAS Ankle-Hindfoot score was 65%. X-Ray and MRI showed Haglund’s deformity with achilles tendon impingement. The patient was diagnosed with Haglund’s deformity, retrocalcaneal bursitis and achilles tendinopathy. Arthroscopic calcaneoplasty, synovectomy and PRP injection was then conducted. One week after operation, pain decreased and she could do daily activities better with AOFAS Ankle-Hindfoot score increased to 87%. Two weeks after operation, pain was still felt but seldom with AOFAS Ankle-Hindfoot score remain at 87%.
Result and Discussion:
Haglund’s syndrome is mostly idiopathic with several factors suggested. Clinical features are back heel pain, swelling, bump on posterior heel and inflammation signs. Dorsiflexion causes pain of the ankle. Lateral radiographic can show bony prominence at posterosuperior of calcaneus, calcaneal spur and bone formation at achilles tendon insertion. MRI can additionally show synovitis, retrocalcaneal bursitis and achilles tendinopathy. Conservative treatment is often used to treat Haglund’s syndrome, if it doesn’t respond well then surgical treatment is required. Arthroscopic calcaneoplasty with synovectomy has better outcome compared to open surgery. PRP injection can be added to enhance achilles tendinopathy healing. The AOFAS Ankle-Hindfoot score used is a standardized evaluation which combine subjective and objective information from the patient and the physician, in which a healthy ankle scored 100. In this case, the AOFAS Ankle-Hindfoot score increased significantly from 65% pre-operative to 87% post-operative which shows better functional outcome.
Conclusion:
Treatment of Haglund’s deformity, retrocalcaneal bursitis and achilles tendinopathy with arthroscopic calcaneoplasty, synovectomy and PRP injection should be considered to produce good functional outcome based on AOFAS Ankle-Hindfoot score
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NewsBot · Nov 9, 2024

Higher BMI Is Associated With Wound Breakdown Following Resection of Haglund Deformity
Kali J. Morrissette, et al
Source

Background:
Haglund deformity is characterized by an enlarged posterosuperior calcaneus, often with inflammation of the retrocalcaneal bursa and Achilles tendon. This study aims to determine if obesity is associated with an increased rate of complications after Haglund resection.
Methods:
A retrospective review was conducted on patients who underwent surgical resection for Haglund deformity from January 2015 to December 2023 at a single academic center. The patient cohort was initially stratified by body mass index (BMI) into normal (BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). For those classified as obese, further subclassification was performed using the standard system: obesity class I (mild obesity) = BMI 30.0-34.9; obesity class II (moderate obesity) = BMI 35.0-39.9; and obesity class III (severe obesity) = BMI ≥40.0. Data on demographics, surgical techniques, and weightbearing were collected and analyzed. Postoperative complications were compared between groups.
Results:
Of the 370 patients included in this study, 20 (5.4%) were classified as normal, 77 (20.8%) were overweight, and 273 (73.8%) were obese. Within the cohort of patients with obesity, 96 (35.2%) were classified as obesity class I, 96 (35.2%) as obesity class II, and 81 (29.7%) as obesity class III.
The obese group had a higher proportion of females (70.0%) and Black/African American race (24.5%), and a higher prevalence of diabetes mellitus (22.0%) and American Society of Anesthesiologists scores compared with other groups. Additionally, analysis within the obesity subclassifications revealed significant differences in smoking status, with a higher proportion of nonsmokers as obesity class increased (58.3% in class I, 76.0% in class II, and 79.0% in class III; P = .01). Follow-up duration averaged 10.5 months, with wound breakdown rates significantly higher in the obese group vs the overweight or normal groups (11.0% vs 2.6% vs 0.0%, P = .02). No significant differences in wound complications or outcomes were observed between patients based on different obesity subclassifications.
Conclusion:
Our findings demonstrate that after Haglund resection, obese patients have a higher risk of complications, particularly wound breakdown. This underscores the necessity of careful patient selection and perioperative optimization.
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NewsBot · Nov 11, 2024

Secondary Achilles Tendon Repair After Calcaneal Exostectomy for Haglund Deformity Using a Unique Surgical Technique
Hoffler, Hayden L. et al
Techniques in Foot & Ankle Surgery 23(2) 108-116, June 2024. | DOI: 10.1097/BTF.0000000000000413

Calcaneal exostectomy with Achilles tendon reattachment and repair is a common procedure used to treat insertional Achilles tendonitis and Haglund deformity. This was first described by Haglund in the early 1900s. Calcaneal exostectomy with Achilles tendon reattachment and repair reduces pain by removing the spur on the back of the heel. We describe a less common operative technique utilizing a Krackow suture technique to create another failure point during the repair of the Achilles tendon.
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NewsBot · Nov 11, 2024

Technique of “Long” Flexor Hallucis Longus (FHL) Harvest for Managing Haglund deformities Requiring Haglund Excision, Achilles Tendon Debridement, and FHL Transfer
Shubham Agrawal aligarhshubham.sa@gmail.com ∙ Ankit Khurana
Source

Purpose: To Describe a Surgical Technique for The Long Flexor Hallucis Longus (FHL) Harvest Used in The Management of Haglund Deformities That Require Haglund Excision, Achilles Tendon (TA) Debridement, And FHL Transfer. Haglund Deformities, Often Cause Pain and Discomfort Due to Irritation of The Surrounding Soft Tissues. Severe Cases May Require Surgical Intervention Involving Haglund Excision and Ta Debridement. Long FHL Tendon Transfer Is an Effective Adjunctive Procedure to Address Significant Achilles Tendon Pathology.
Methodology: A Longitudinal Incision Is Made Along the Medial Border of The Achilles Tendon. The Bony Prominence (Haglund) Is Identified and Excised Using an Oscillating Saw or Bone Rongeur. Degenerated Portions of The Achilles Tendon Are Debrided. The FHL Tendon Is Located Through a Separate Medial Incision at The Level of The Navicular. The Tendon Is Traced Proximally Released from Its Insertion at The Distal Phalanx of The Great Toe. The Harvested FHL Tendon Is Then Routed Through the Calcaneus and Sutured on Itself with Non-Absorbable Robust Sutures.
Results: The Technique Allows for Effective Management of Complex Haglund Deformities and Associated Achilles Tendinopathy. Patients Typically Experience Significant Pain Relief and Improved Function Postoperatively. The FHL Transfer Provides Additional Strength and Support to The Achilles Tendon, Reducing the Risk of Recurrence.
Conclusion: Long FHL Harvest and Transfer Is a Valuable Technique in The Surgical Management of Haglund Deformities with Associated Achilles Tendon Pathology. It Offers a Robust Solution for Restoring Function and Alleviating Pain in Affected Patients with No Need of Implant Making It Cost Effective.
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Surgery for Haglunds / Retrocalcaneal Bursitis

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Surgery for Haglunds / Retrocalcaneal Bursitis

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haglunds surgery #2

The 100 Most Impactful Articles in Foot and Ankle Surgery

The Complexities of Self-Harm in Foot & Ankle Surgery

Hallux Valgus Surgery is Failing Long Term

Podiatric surgery: a canary in the coalmine for professional monopolies

Jones Fracture surgery

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