Higher BMI is Associated with Wound Breakdown Following Resection of Haglund’s Deformity

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Category: Hindfoot; Ankle Introduction/Purpose: Haglund’s deformity is a common orthopedic condition characterized by the enlargement of the posterosuperior prominence of the calcaneus, often accompanied by inflammation of the retrocalcaneal bursa and Achilles tendon. While initial management of Haglund’s deformity consists of conservative measures, surgical intervention may be indicated if symptoms fail to resolve within 6 months. Although effective, surgical management is not without complications especially for patients with diabetes and obesity. Given obesity is one of the few modifiable risk factors when considering ideal surgical candidacy, understanding its relationship to complication status is vital. This study therefore aims to compare postoperative complications between obese and nonobese patients with Haglund deformity, filling a gap in the literature and aiding decision-making in managing this condition during the burgeoning obesity epidemic. Methods: Following institutional approval, retrospective data was collected from 476 patients who underwent resection for Haglund’s deformity between January 2015 and December 2023. All procedures were performed at a single academic center by either one of six fellowship-trained foot and ankle surgeons. To evaluate the impact of BMI on postoperative outcomes the cohort was dichotomized into obese (BMI ≥ 30 kg/m^2) and nonobese. Patient demographic data and surgical repair technique data (suture bridge – SB, corkscrew – CS, suture anchors – SA), post-operative weightbearing status (weightbearing as tolerated -WBAT, non-weightbearing – NWB, partial weightbearing – PWB, touch down weightbearing – TDWB), complications, revisions, and date of patients’ last follow-up were recorded. Statistical analysis involved descriptive summaries, univariate comparisons, and multivariate regression to identify risk factors for wound complications. P values < 0.05 were considered statistically significant. Results: Demographic characteristics were similar between groups in terms of age, sex, race, and smoking status. Surgical techniques varied among surgeons, with suture-bridge being the most common (57.9%). Postoperatively, most patients were NWB (68.7%), followed by TDWB (14.4%), WBAT (13.9%), and PWB (2.3%). Repair type and postoperative weightbearing status did not significantly differ between non-obese and obese groups. Around 20.0% of patients experienced complications, with persistent pain and wound breakdown being the most common (10.3% and 8.2%). Obese patients had a significantly higher incidence of any complication compared to non-obese patients (p=0.03), PWB (10.6% vs. 1.9%, p=0.003). Multivariable logistic regression indicated that obese patients had over six times the risk of wound breakdown compared to non-obese patients (OR=6.57, 95% CI [0.57-3.76], p=0.02). Conclusion: Haglund's deformity presents a significant orthopedic challenge, often requiring surgical intervention after failed conservative management. This study highlights the importance of understanding the impact of obesity on postoperative complications in Haglund's resection. Our findings demonstrate that obese patients have a higher risk of complications, particularly wound breakdown, compared to non-obese counterparts. This underscores the necessity of careful patient selection and preoperative optimization, especially in the context of the growing obesity epidemic. By shedding light on this relationship, our study contributes valuable insights to the literature, aiding clinicians in decision-making and improving outcomes for patients undergoing surgical management of Haglund's deformity.