Haglund's Deformity Research Articles

Rearfoot disorders and conservative treatment: a narrative review.

Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Heel lifts, rocker shoes, and the AirHeel Brace can be used to reduce symptoms. Haglund's deformity is an osseous prominence of the posterosuperior part of the calcaneus bone, the pain from which can be alleviated by reducing pressure on the affected area by appropriately modifying the back of the shoe to prevent contact with the lesion. The pain from retrocalcaneal bursitis can be controlled by lifting the heel and loosening the shoe counter. Plantar fasciitis causes plantar heel pain, and its orthotic treatments include the application of a heel cup, heel pad, heel wedge, Thomas heel, and night splint. Calcaneal stress fractures are generally caused by repetitive loads and occur mainly in sporting activities. Patellar tendon-bearing (PTB) orthoses are helpful in reducing the load on the calcaneal bone. Heel fat pad atrophy refers to the loss of the fat pad that absorbs shock in the heel. To reduce pain caused by heel fat pad atrophy, rocker soles, heel pads, and solid ankle cushion heels (SACHs) may be used. Tarsal tunnel syndrome is caused by compression of the tibial nerve within the tarsal tunnel and its symptoms can be managed by rocker soles, supporting medial arches, Thomas heels, and SACHs. Shoe modification or application of orthoses can be helpful for managing rearfoot pain. However, for the active and wide application of these conservative treatment methods, more clinical studies should be conducted.

Retrocalcaneal Spur Removal and Achilles Tendon Reattachment for the Treatment of Haglund Deformity

Insertional Achilles tendinopathy frequently involves intratendinous calcification of the Achilles tendon insertion and a prominent superolateral calcaneus tuberosity known as a Haglund’s deformity. The incidence of insertional Achilles tendinopathy is up to 30%, affecting both recreational and elite athletes. The indications for surgical treatment of insertional Achilles tendinopathy is appropriate when a patient’s symptoms are recalcitrant to nonoperative therapies. Advancements in surgical treatment include the utilization of the midline longitudinal incision, improved soft tissue handling, and minimizing the detachment of the Achilles tendon insertion during surgery. Surgical treatment includes removal of the Haglund’s deformity, debridement of the Achilles insertion, and bone to tendon repair utilizing a double-row suture anchor construct. The authors are presenting a unique surgical technique for Haglund’s deformity excision, Achilles debridement, and repair without flexor hallucis longus augmentation. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Functional follow-up after endoscopic calcaneoplasty for Haglund's deformity using the biodex isokinetic muscle testing system: A case series.

Isokinetic muscle strength test implemented by the Biodex system is a method used for evaluating muscle function that has been applied clinically in the field of sports and rehabilitation medicine. However, information on its application on Haglund's deformity remain insufficient. Therefore, the present study examined the effectiveness of the muscle strength test using the Biodex system in evaluating the recovery of athletic capacity in patients with Haglund's deformity following endoscopic surgery. In total, 34 patients treated by the authors from June 2012 to November 2018 at Peking University Third Hospital (Beijing, China) were included. To compare muscle strength before surgery, then 3 and 6 months after surgery, using the uninjured side as the control, the Biodex system test was conducted in parallel to the collection of the American Orthopaedic Foot and Ankle Score values and visual analog scale scores. The Biodex system test results showed that Haglund's deformity mainly hinders plantar flexion strength. Patients recovered daily living capacity within 3 months and athletic capacity within 6 months following surgery, which matched the AOFAS values, VAS scores and the self-assessments of the patients. These findings suggest that the Biodex system can dynamically reflect the degree of postoperative recovery in Haglund's deformity.

Endoscopic management of retrocalcaneal pain: a prospective observational study

<p class="abstract"><strong>Background:</strong> In an effort to reduce morbidity and complications of open surgery, an endoscopic technique was used for the management of the conditions leading to retrocalcaneal pain. With this purpose, the current study was undertaken to evaluate results of endoscopic management of retrocalcaneal pain using American orthopaedic foot and ankle score (AOFAS).</p><p class="abstract"><strong>Methods:</strong> 20 patients (26 heels) in the age group 18-80 years presenting with retrocalcaneal pain not responding to conservative management underwent endoscopic decompression of the retrocalcaneal bursae and excision of bony spurs. Two portals were created, one laterally and one medially, over the posterosuperior portion of the calcaneus to gain access to the retrocalcaneal space. The inflamed bursal tissue was identified and removed, and the prominent bone was resected. The functional outcome was evaluated pre and postoperatively with the AOFAS.<strong></strong></p><p class="abstract"><strong>Results:</strong> 70% patients have retrocalcaneal bursitis, 20% Haglund’s deformity as confirmed on lateral view of ankle X-ray and only 10% of non-insertional tendinosis. Mean operative time was 54.95 minutes. Mean duration of hospital stay was 3.90±0.64 and the mean follow-up was 66 days (range 30-180 days). The average AOFAS score improved from 65.60 points pre-operatively to 96.80 points at final follow-up. There were fifteen excellent results, seven good results, two fair results and two poor results.</p><p class="abstract"><strong>Conclusions:</strong> Endoscopic procedure for retrocalcaneal bursitis and Haglund deformity seemed to be a safe and efficacious option for surgical treatment of retrocalcaneal pain.</p>

Use of Ultrasonically Interdigitated Anchors in Haglund's Deformity Correction Surgery.

Haglund's deformity is a common cause of foot pain, with high success rates of surgical intervention. Because early weightbearing rehabilitation correlates with better surgical results, the integrity of anchors employed in these surgeries needs to be evaluated for proper fixation strength, leading to improved postoperative outcomes. The ultrasonically interdigitated anchor is a biodegradable suture anchor that is melted into bony trabeculae using ultrasound, leaving a small biological footprint and less interference on computed tomography and magnetic resonance imaging scans, without loss of fixation strength. We performed a review of 44 patients aged 26 to 84 years treated with either ultrasonically interdigitated anchors or fully threaded titanium anchors during Haglund's deformity excision. Overall, 7 of 14 patients who received an ultrasonically interdigitated anchor reported raw PROMIS (Patient-Reported Outcomes Measurement Information System) scores averaging 14.3, with an average return to ambulation time of 4.2 weeks. Fifteen of 30 patients receiving a fully threaded titanium anchor reported raw PROMIS scores averaging 9.7, with an average return to ambulation time of 3.5 weeks. We found little difference between the outcomes between the 2 anchors and no massive failures or infections in either group, implying that ultrasonically interdigitated anchors are a viable option for Achilles tendon reattachment during Haglund's deformity repair surgery.Levels of Evidence: Level III: Case control study.

Haglund deformity – Resection by lateral approach: A case report and review of literature

Haglund deformity – Resection by lateral approach: A case report and review of literature

The Central-Splitting Approach for Achilles Insertional Tendinopathy and Haglund Deformity.

Place the patient in the prone position with the feet at the edge of the operating table. Make a full-thickness, 5 to 7-cm longitudinal incision centered over the Achilles tendon and the posterior aspect of the calcaneus. Make a central incision through the Achilles tendon. Sharply mobilize the medial and lateral slips and excise the diseased portion of the Achilles tendon. Expose the calcaneal exostosis and perform the calcaneal exostectomy with a microsagittal saw. Repair the remaining healthy-appearing Achilles tendon to the calcaneus with 2 suture anchors. An additional suture anchor or, alternatively, the double-row technique for the Achilles tendon repair may be used. Repair the central split in the Achilles tendon with absorbable suture. Close the soft tissue and skin in layers. Alternative approaches include the medial, lateral, or Cincinnati transverse incisions. The central-splitting approach is favored because of the excellent exposure of both the diseased tendon and the calcaneal exostosis. Additional augmentations to this procedure include a flexor hallucis longus transfer and a gastrocnemius recession. This technique provides adequate exposure to the diseased Achilles tendon, calcific deposits, and calcaneal exostosis. Recent studies have demonstrated it to be a safe and effective technique with high patient-satisfaction scores5-13.

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

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.

Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up

Background: Avulsion fracture of the Achilles tendon is a less common but debilitating disorder. There is a paucity of literature on this problem. Purpose: To present a retrospective case series assessing the clinical outcomes of avulsion fracture of the Achilles tendon after a reattachment procedure and to identify potential factors predicting postoperative outcomes. Study Design: Case series; Level of evidence, 4. Methods: A consecutive case series of 35 patients with acute insertional rupture of the Achilles tendon who received a reattachment procedure between 2011 and 2017 were reviewed. All patients were measured and classified by magnetic resonance imaging (MRI) and surgical findings. Patient-reported outcomes were evaluated using the visual analog scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI), Tegner score, and Ankle Activity Score (AAS). The range of motion and single-legged heel raise test were also conducted for both ankles. Results: Thirty-one out of 35 (88.57%) patients were followed up for an average of 43.65 months. The VAS pain score and AOFAS Ankle-Hindfoot score improved from 4.87 ± 1.61 preoperatively to 2.07 ± 1.57 postoperatively and from 58.32 ± 18.66 preoperatively to 87.32 ± 7.53 postoperatively, respectively (both P < .001). The mean FFI, AAS, and Tegner scores after the operation were 11.84 ± 1.62, 5.71 ± 2.18, and 4.61 ± 1.31, respectively. Compared with the intact ankle, the mean deficit in dorsiflexion in the involved ankle was 9.54°± 6.25° (range, 0.59°-23.70°; P < .001) and the mean deficit in plantarflexion in the involved ankle was 6.31°± 4.02° (range, 0.24°-14.92°; P < .001). Thirty patients could perform the single-legged heel raise on the operative leg. A larger body mass index was associated with worse postoperative AOFAS and FFI outcomes. Longer follow-up predicted statistically significantly better FFI scores. Better postoperative dorsiflexion was associated with better postoperative FFI, AAS, and Tegner scores, and a statistically significant interaction was found between the VAS score and plantarflexion deficit. Age, preoperative insertional tenderness, Haglund deformity, and MRI classification showed little association with postoperative outcomes. Conclusion: This study demonstrated that the reattachment procedure for acute avulsion fracture of the Achilles tendon can achieve firm fixation and promising outcomes.

Surgical Resection of Haglund's Deformity by Achilles Tendon Splitting Approach

AbstractBackground: Haglund's deformity was first described by Patrick Haglund in 1927 [1]. It is also known as retro-calcaneal exostosis. It is one of the causes of posterior heel pain. Several methods have been described for treatment including conserv-ative measures and surgical measures.Aim of Study: The aim of this study is to evaluate results of surgical resection of Haglund's deformity by Achilles tendon splitting approach.Patients and Methods: In this prospective study, 21 cases with were Haglund's deformity treated with surgical resection through Achilles tendon splitting approach.Results: These cases were assessed according to AOFAS score [2], the functional results were graded as excellent in twelve patients (57.1%), good in eight patients (38.1%), fair in one patient (4.8%), with no poor results. The excellent and good results were considered as satisfactory ones while the unsatisfactory included the fair results. Thus, satisfactory results were found in 20 patients (95.2%), and the unsatisfac-tory ones were found in 1 patient (4.8%).Conclusion: This study proves that central splitting tech-nique for the surgical treatment of Haglund's deformity is an effective treatment with good exposure of retrocalcaneal space, with decrease risk of vascular and nerve injury, and acceptable outcome.

MRI in patients with Haglund's deformity and its influence on therapy.

Heel pain is one of the common reasons why patients consult orthopaedic surgeons in an outpatient setting. The dorsal heel pain is often caused by a Haglund's deformity which is an exostosis of the posterior superior calcaneus. It often leads to Haglund's syndrome with calcaneal bursitis and Achilles tendinosis. This study aims to investigate the roll of MRI in diagnosis of Haglund's syndrome and its influence on therapy. We retrospectively analysed data of 45 patients which clinically and radiologically confirmed Haglund's deformity. Patients were divided into two groups that either did not receive MRI (MRI_0) or received MRI (MRI_1). To evaluate the significance, Fisher´s test was used. A statistical significance was assumed at p < 0.05. The average age was 57.0years. There was no significant difference in therapy comparing the groups MRI_0 and MRI_1. Haglund's syndrome was detected in 86.7% of all patients with Haglund's deformity. MRI does not influence the therapy of patients with Haglund's deformity. Therefore, the resources of this cost-intensive and limited type of investigation should be used elsewhere. In cases of atypical heel pain, the MRI might be useful.

Treating Haglund's Deformity with percutaneous Achilles tendon decompression: a case series

Treating Haglund's Deformity with percutaneous Achilles tendon decompression: a case series

Алгоритм определения объема хирургического вмешательства при деформации Хаглунда у спортсменов

Objective: to develop an algorithm for determining the extent of surgical intervention for pain in the heel region based on a comprehensive clinical and instrumental assessment of the functional state of the lower extremities. Materials and methods: during the examination of 18 athletes with pain in the heel area, we used a thermal imaging examination (at rest and after exercise) in combination with magnetic resonance imaging data. Infrared thermography was performed using an infrared camera. Data analysis was carried out using the specialized online service tvision.pro, which allows you to track the dynamics of the patient's thermographic picture. The combination of images of thermographic and MRI studies makes it possible to assess the functional state of the structures of the heel region with the identification of the structures most involved in the pathological process. Results: based on the experience of treating athletes with pain in the heel area, we developed an algorithm for determining the extent of surgical intervention for Haglund deformity. The algorithm is based on the analysis of MRI data and their comparison with the results of the examination of the soft tissue of the heel area using functional thermal imaging. Conclusions: a comprehensive analysis of the data of thermographic and tomographic studies allows you to perform an objective assessment of the functional state of the patient based on the primary localization of the pathological process. The developed algorithm is applicable for planning the extent of surgical intervention and making a choice of preferable technique. The proposed tactic contributes to early return to competitive load. The infrared thermography technique provides important additional data on the functional state of the athlete's musculoskeletal system. It is absolutely safe for both the patient and the specialist who conducts the study.

A prospective study of excision of bony eminence in haglund deformity for treating retrocalcaneal bursitis

The aim of this study is to analyse the outcome of surgical management of Haglund’s deformity. Haglund’s deformity is a prominence in the posterolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by conservative methods alone. This study is to evaluate the surgical outcomes of excision of Haglund’s deformity by the lateral approach. During the period from Feb 2017 to Jan 2018, 20 patients underwent excision of Haglund’s deformity using lateral approach and their functional outcome was analyzed using AOFAS Score. The mean AOFAS score at the follow up was 86/100, with significantly decrease in pain at one year follow up. The lateral approach to deformity excision can be an effective treatment for those suffering from Haglund’s deformity.

Seasonal Variation of Achilles Tendon Injury.

Background:Achilles tendon rupture (ATR) is a common injury with increasing incidence. Several risk factors have been identified; however, little is known about seasonal variations in injury prevalence. Previous reports have generated mixed results, with no clear consensus in the literature. The purpose of this investigation was to retrospectively review ATRs seen at a major academic orthopaedic surgery department in New York City to determine whether a statistically significant seasonal pattern of ATRs exists.Methods:A retrospective chart review was conducted, identifying patients with an acute ATR. Patients were excluded if they had a chronic rupture, laceration, débridement for tendinitis, Haglund deformity, or other nonacute indications for surgery. Date and mechanism of injury were determined from the clinical record.Results:The highest rate of injury was seen in spring (P = 0.015) and the lowest in fall (P < 0.001), both of which were statistically significant. Overall, no statistically significant difference was noted in summer or winter, although more injuries were seen in summer. When only sports-related injuries are considered, a similar trend is seen, with most injuries occurring in spring (n = 48, P = 0.076) and fewest in fall (n = 25, P = 0.012); however, only the lower number in fall reaches statistical significance. No statistically significant difference was noted between seasons when only non–sports-related injuries were considered.Conclusion:A statistically significant increase was noted in the incidence of ATRs in spring and a statistically significant decrease in fall. The need for recognition of risk factors and preventive education is increasingly important in the orthopaedic surgery community and for primary care physicians, athletic trainers, coaches, and athletes.Level of Evidence:Prognostic level IV

Surgical resection of Haglund deformity by lateral approach: our institutional experience on 29 heels

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Haglund deformity is a common cause of posterior heel pain and consists of a constellation of soft tissue and osseous abnormalities. The treatment starts with conservative approach and ends with surgical treatment in case conservative treatment fails and the symptoms are bothersome. Different surgical procedures and approaches have been used for this deformity. But in the literature, the results have been inconsistent. In this study we evaluated the clinical and functional outcome of osteotomy of the calcaneal tuberosity with debridement of the retrocalcaneal bursa and the Achilles tendon using a lateral approach at our institute.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 29 feet in 25 patients that underwent surgical procedure from August 2013 to March 2017 at our institute were included in this study. The clinical and functional outcome was evaluated using AOFAS ankle-hind foot scale.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean AOFAS ankle-hind foot score had improved by 32 points from the pre-operative mean score, with a mean score of 86 at the final follow up of one year. Five out of 29 operated feet had superficial surgical site infection in the postoperative period that responded to antibiotic therapy and regular antiseptic dressings. One patient had local betadine allergy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude lateral approach to debridement and calcaneal tuberosity resection is an effective method with good clinical and functional outcome in patients with refractory Haglund deformity. &lt;/p&gt;

Surgical treatment for Haglund's deformity

Surgical treatment for Haglund's deformity

Endoscopyic calcaneoplasty for Haglund's deformity.

Endoscopyic calcaneoplasty for Haglund's deformity.

Clinical presentation and surgical management of chronic Achilles tendon disorders — A retrospective observation on a set of consecutive patients being operated by the same orthopedic surgeon

BackgroundNon-invasive treatment is not always successful in patients with Achilles tendon disorders, and surgical treatment is instituted as the next step. There is sparse knowledge about the diagnoses, pain levels before surgery, surgically confirmed pathologies and postoperative complications in large patient groups. AimsTo study the diagnoses, pain scores before surgery, macroscopic surgical findings and postoperative complications in a series of patients treated for Achilles disorders. Material and methodsOne surgeon operated on 771 Achilles tendons of 481 men and 290 women during a 10-year period. The clinically and ultrasound confirmed diagnoses, pre-operative pain and functional scores (Visual Analogue Scale, VAS, range 0-100; Victorian Institute Sports Tendon Assessment — Achilles questionnaire, VISA-A), macroscopic findings during surgery and postoperative complications, were retrospectively collected from a database. ResultsClinically, by ultrasound and during surgery midportion Achilles tendinopathy was confirmed in 519 (67%) patients, 41% of them had a thickened plantaris tendon located close the Achilles tendon. Partial midportion rupture was found in 31 (4%) patients, chronic midportion rupture in 12 (2%) patients and insertional Achilles tendinopathy, including superficial and retro-calcaneal bursitis, Haglund deformity, distal Achilles tendinopathy, plantaris tendon pathology, and bone spurs, in 209 (27%) patients. The mean pre-operative pain scores for midportion Achilles tendinopathy were 73 (VAS) and 45 (VISA-A), and for insertional Achilles tendinopathy 77 (VAS) and 39 (VISA-A). For midportion Achilles tendinopathy there were 14 (3%), and for insertional Achilles tendinopathy 10 (5%), postoperative complications. ConclusionsPatients presenting high pain scores from midportion Achilles tendinopathy were the most common. Plantaris tendon involvement is a frequent observation. For insertional Achilles tendinopathy the combination of pathology in the subcutaneous and retrocalcaneal bursa, a Haglund deformity and distal Achilles tendinopathy/tendinosis was most frequent. Series study, Level of evidence: 4.

Calcaneus Exostectomy and Achilles Tendon Reattachment for the Treatment of Haglund Deformity

Insertional Achilles tendinosis with Haglund deformity is a common cause of posterior heel pain and the diagnosis can be established by history, physical examination, and imaging. Operative treatment may be required if the conservative treatment has failed. A common surgical procedure usually includes open debridement of Achilles tendon and retrocalcaneal bursa, exostectomy of posterior superior aspect of the calcaneus, and reattachment of the Achilles tendon using a double-row suture anchors. The results of these procedures demonstrated significant improvement of functional outcomes and pain relief with minimal complications. Level of Evidence: Diagnostic Level V. Expert Opinions.