Varied Surgical Approach to the Retrocalcaneal Spur and Haglund Deformity: A Technique Guide

Abstract

An enlargement of the posterosuperior aspect of the calcaneus, also known as Haglund deformity, is often associated with Achilles tendonitis/tendinosis and retrocalcaneal bursitis. A retrocalcaneal spur is associated with chronic pain from activity and shoe pressure. Both of these conditions are treated with conservative therapy, which provides reliable results. However, surgical intervention may be required for recalcitrant or severe cases and has the opportunity to provide relief when nonoperative measures fail. Many surgeons address both conditions through similar surgical dissection. The posterior heel has relatively little tissue overlaying the surgical site and traditional posterior heel surgery with calcaneal osteotomy and Achilles repair through posterior incisions has proven to be effective in correction of the deformity. However, the need for large amounts of suture and suture knots, during the repair can lead to wound complications after the repair, even with varied incision placement. Because of this, many surgeons are utilizing a knotless suture anchor technique to eliminate the bulky nature of the suture at the posterior heel and prevent unwanted suture reaction at the site. Using the same surgical approach for both conditions causes an increased operative time and recovery than necessary for those with Haglund deformity. A lateral approach can be performed, as complete Achilles detachment does not need to be performed in this group. This paper outlines 2 separate surgical techniques, with the use of knotless suture anchors, for treatment of these conditions and the surgical approach that may be used for each condition. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.