Hind-foot endoscopic decompression of the retrocalcaneal space as an appropriate treatment for refractory Haglund’s syndrome

Abstract

Background The traditional operative management of Haglund deformity and retrocalcaneal bursitis consists of an open excision of the inflamed bursa, resection of the posterosuperior calcaneal tuberosity, and debridement of the Achilles tendinopathy. In an effort to reduce morbidity and recovery time, an endoscopic technique was used for the management of this condition. The purpose of the current study was to evaluate the results from our patient series through the use of endoscopic bony and soft-tissue decompression of the retrocalcaneal space, calcaneal tuberosity resection, and Achilles tendon debridement as an appropriate treatment for refractory Haglund’s syndrome. Patients and methods Between January 2014 and June 2015, endoscopic management of Haglund’s syndrome was performed on 26 feet in 22 patients. The study included six males (six heels) and 16 females (20 heels), with a mean age of 24.3 years (range, 18–35 years). All patients experienced symptoms for a mean duration of 12.9 months (range, 8–20 months) before the operation. Patients were evaluated preoperatively and postoperatively with the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results The mean follow up period was 18 months. All patients (26 heels) were available for follow-up. The American Orthopaedic Foot and Ankle Society scores averaged 62 preoperatively and 97 postoperatively. There were 17 excellent results, seven good results, and two poor results. One major complication occurred was an Achilles tendon rupture 3 weeks after surgery and residual pain and swelling that required reoperation through an open procedure. There were no wound complications or postoperative infections. Conclusion An endoscopic procedure seemed to be a safe and efficacious option for surgical treatment of Haglund’s syndrome. Sufficient exposure of the Achilles tendon and removal of the calcaneal prominence and retrocalcaneal bursa can be done effectively using an endoscopic technique and has a low morbidity and high patient satisfaction. The time to return to normal activity level is short.