Haglund's Disease Research Articles

Endoscopic Calcaneoplasty in Haglund Disease: Surgical Technique, Clinical and Subjective Outcomes.

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. 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. 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. In this relatively small cohort, we found that endoscopic calcaneoplasty was associated with good clinical and subjective results with few complications.

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.

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. 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. 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. 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. Level II, grade A recommendation.

Platelet rich plasma (PRP) in the surgical treatment of Haglund's syndrome: the use of PRP membranes as an intra-operative local adjuvant.

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.

Endoscopic Calcaneoplasty in Haglund's Disease: Surgical Technique, Clinical and Subjective Outcomes

Category: Arthroscopy; Ankle Introduction/Purpose: During the last decade, arthroscopic procedures have been replacing open techniques in Haglund's disease treatment due to their considerable advantages. Endoscopic calcaneoplasty is a technique that allows resection of posterosuperior calcaneal exostosis and retrocalcaneal bursitis. The objective of this article is to describe this technique and report its clinical and subjective outcome. Methods: A retrospective cohort study was carried out in patients who underwent endoscopic surgery between July 2014 and March 2020. The patients were clinically and radiologically evaluated. All cases included were studied prior to the intervention and postoperative. All patients who did not show any clinical improvement after 6 months of conservative treatment were surgically treated with endoscopic treatment in the prone position through two posterior arthroscopic portals. Results: In this study, 14 endoscopic calcaneoplasties were performed in 14 patients, with an average follow-up of 40 months. The visual analog scale improved from a preoperative average value of 9.07 to 1.79 after surgery (p> 0.0001). The AOFAS scale rose from 38.71 before surgery to 94.57 postoperative (p> 0.0001). Good subjective results were observed in twelve patients ( 85.71%) and all of them would have surgery again. There were no wound complications or infections. No patient required reoperation. Conclusion: Endoscopic treatment is a useful technique, with good clinical and subjective results and few complications, being a good alternative to open techniques.

Surgical Treatment of Haglund's Disease: About 9 Cases

Haglund's disease is a rare disease of the hindfoot, linked to a morphological anomaly of the calcaneus postero-superior 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.

Haglund's Disease with Clinical and Radiological Findings: 3 Case Reports

Objective: Haglund's Deformity is a variation of the posterosuperior region enlargement of the Os Calcaneus (OC) in the form of exostosis. It is associated with Haglund's Disease (HD), which encompasses Achilles tendinitis, retrocalcaneal bursitis, supra calcaneal bursitis, and inflammation of the Kager fat pad. Diagnosis is based on clinical findings and radiological methods, such as lateral ankle radiographs, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). This study aims to present three cases of ankle pain diagnosed with HD using radiological imaging. The mean age of our cases was 44.6 years, with two females and one male. Patients commonly present with complaints of pain and swelling behind the heel. Results: Physical examination revealed pain and tenderness upon palpation over the left OC and Achilles tendon insertion. Radiological examination showed osseous protrusion in the posterosuperior part of the OC, indicating Haglund's Deformity. Edema was observed at the bony prominence of the posterosuperior OC, Kager fat pad, and heel area. The treatment plan for all three patients included leg rest splint, anti-inflammatory medication, and physical therapy. Conclusion: In cases of heel pain where traumatic events such as acute fractures are ruled out, MRI should be performed, and Haglund's Syndrome should be investigated if osseous protrusion in the posterosuperior calcaneus is observed on radiographs, along with other findings suggestive of HS.

Haglund's Disease: A Case Report

Haglund's disease is a relatively under-appreciated pathology, linked to calcaneo-achilles impingement. The etiology is not well known, and may be confused with other causes of talalgia. We report the case of a 55-year-old patient presenting with painful ankle oedema. The diagnosis was evoked on a standard weight-bearing X-ray of the left ankle and on ultrasound, and confirmed by an MRI of the ankle, showing a fissure with signal abnormality of the achilles tendon in relation to the oedema associated with preachilean bursitis. Treatment, initially medical, resulted in surgical resection of the posterosuperior angle of the calcaneus with good clinical outcome.

Haglund's Syndrome

Background: Haglund's syndrome an important cause of posterior heel pain presents with a prominent bony contour, a retrocalcaneal bursitis or achillis tendinitis these can also occur in isolation hence for the diagnosis of etiology of Haglund's disease certain radiological parameters and soft tissue parameters have been created to evaluate the anatomical variations which will assist in its exact diagnosis. Study aims to distinguish between the bony and soft tissue causes of Haglund's disease radiologically. Methodology: After Institutional ethical committee clearance an observational cross-sectional study was conducted with subjects coming to radiology OPD for X-ray foot with complains of posterior heel pain fulfilling inclusion and exclusion criteria were examined for X-ray lateral view of foot. Parameters like calcaneal inclination angle (CIA), Fowler Philip angle (FPA), parallel pitch line (PPL), Steffenson & Evenson angle (SEA) measured, posterior/calcaneal spur and posterior calcaneal step were noted. The data obtained was analyzed for mean, Standard deviation, sensitivity % and false negative %. Result: Sensitivity of the parameters were analyzed to find CIA, SEA &PPL to be 63.3%, 55% and 55% sensitive respectively. CIA could be assigned most sensitive but regarding soft tissue parameters none were sensitive. Conclusion: CIA, SEA & PPL were found to be sensitive among bony parameters. But none of the soft tissue parameters were sensitive radiologically highlighting a need for its correlation with clinical symptom in peripheral health centers where MRI is not available. Sensitivity of bony and soft tissue parameters were analyzed to find CIA, SEA & PPL to be sensitive. CIA could be assigned most sensitive among bony parameter but with regards to soft tissue parameters none were sensitive.

Outcomes in Open and Endoscopic Treatment for Haglund's Syndrome and Insertional Achilles Tendinopathy

Category: Arthroscopy; Ankle; Hindfoot; Sports Introduction/Purpose: Haglund's syndrome is a common cause of posterior heel pain and can be associated with retrocalcaneal bursitis and degenerative Achilles tendinosis. Open approaches for resection of the Haglund's lesion have long been employed in patients that fail to improve with conservative treatment. This often involves partial elevation of the Achilles insertion with reattachment. More recently, endoscopic surgical techniques have evolved, enabling more rapid rehabilitation with less tendon disruption. The decision on the surgical approach is influenced by the degree of insertional Achilles tendinosis with endoscopic techniques preferred in the absence of insertional pathology. The primary objective of this investigation was to report on a large series of patients treated surgically for symptomatic Haglund's lesions. Methods: We reviewed the outcomes of Haglund's syndrome surgical cases at our institution over a five-year period. We included cases with insertional Achilles tendinosis and retrocalcaneal bursitis related to the Haglund's lesion, but excluded revisions and cases involving flexor hallucis longus tendon transfers. We recorded patient demographics, sport and activity level, comorbidities, BMI, duration of symptoms, surgical technique, tourniquet time, rehabilitation protocol, postoperative complications, and duration of postoperative follow-up. We also reviewed relevant preoperative imaging and recorded the presence of Achilles insertional degenerative calcification or an insertional calcaneal enthesophyte on radiographs. We then prospectively administered questionnaires regarding return to sport and patient-reported outcome measures including the SANE, PASS, VISA-A and PROMIS (Physical Function, Pain Interference and Global Health domains). Results: In total, 17 of the 77 (22%) included cases were performed with the endoscopic surgical technique. Six patients underwent bilateral Haglund surgeries during the study period, accounting for 12 of the 77 cases. The open Haglund resection group had a higher rate of concomitant Achilles insertional degenerative calcification on radiographs and MRI (72%). In addition, the open group was older than the endoscopic group (average age 54 vs 45), had a higher rate of comorbidities, higher rate of postoperative complications, and a higher rate of return to the operating room for revision surgery (11% vs 0% for endoscopic). Seventeen patients were elite distance running athletes and were preferentially treated by endoscopic techniques (11/17, 64%). At 24-month follow-up, the majority of patients report return to baseline activity. Conclusion: Patients treated surgically for Haglund's syndrome and insertional Achilles tendinopathy generally have good outcomes. Outcomes are better for endoscopically treated patients compared to open treatment, although these patients tend to be younger, healthier, and have less Achilles tendons disease. Still, some degree of Achilles tendinopathy and limited intrasubstance calcification can be successfully addressed with the endoscopic technique. We are endeavoring to better define indications for, and limitations of, the endoscopic technique for insertional Haglund's disease.

A comparative study between platelet-rich plasma, corticosteroid, and autologous whole blood injection in patient of plantar fasciitis

Introduction: Majority of the patient with heel pain are diagnosed with plantar fasciitis (PF). PF is the condition characterized by isolated inferior heel pain particularly with the first steps of the day or after sitting for hours and the reason is due to degeneration of the plantar fascia and perifascial structures. Regular walking on hard surfaces, wearing hard sole footwear, and obesity are the risk factors for this condition. Injecting steroids is the most popular method of treating the condition but has its own advantages and disadvantages. There have been cases reported of rupture of plantar fascia after giving corticosteroid injections, especially when it was given repeatedly. Platelet-rich plasma (PRP) is known to enhance the healing process of the body as it has platelet-derived growth factors that boost the healing of soft tissue, bone healing, and also tendon healing. Aims and Objective: The objective of our study was to know among the PRP injection, autologous whole blood steroid injection which is a superior mode of intervention in PF management. Materials and Methods: A sample size of 225 was taken and patients were divided into 3 groups, in which Group A was given PRP injection, Group B was given steroid injection, and Group C was given whole blood. The follow-up was done on 2 weeks, 4 weeks, and 12 weeks. Patients of age more than 18, those who were clinically diagnosed PF, and those who were not improving with 3 months of conservative management were included in the study. Patients with any ligament injury or with Buerger’s disease, pseudo-gout, and Haglund disease were excluded from the study. All patients were asked for their pain to quantify it according to visual analog scale (VAS) scale and the score was noted on pre-injection follow by on 2 weeks, 4 weeks, and 12 weeks. Results: The VAS score before infiltration was almost similar (P > 0.05) in Group A (7.8 ± 1.26), Group B (7.5 ± 1.05), and Group C (7.8 ± 0.87). The VAS score significantly decreased in Group B who were injected steroids in the initial 2 weeks when compared to that of Group A who were injected PRP and Group C who were injected whole blood. A significant decrease in VAS was seen in Group A at after 12 weeks when compared to Group B and Group C. Conclusion: Our study showed that autologous PRP therapy can lead to a sustained reduction in symptom complaints when compared to corticosteroid injections and autologous whole blood. PRP injection holds promise as a potential therapy to hasten the healing of chronic PF.

Transtendinous approach calcaneoplasty versus endoscopic calcaneoplasty for Haglund's disease.

In this study, we performed a comparison between open calcaneoplasty through transtendinous approach and endoscopic calcaneoplasty for Haglund's disease. A retrospective review was performed of patients who had undergone either a calcaneoplasty with transtendinous approach or endoscopic for Haglund's disease from three centres. Inclusion criteria were patients with Haglund's disease confirmed radiographically, neutral alignment of the hindfoot and at least one year of follow-up. Patients were excluded in case of ipsilateral ankle osteoarthritis or other neighbouring joints, previous foot surgery, hindfoot malalignment and marked calcific insertional Achilles tendinosis. A chart review was performed to collect demographic data, including age, sex and body mass index (BMI). Functional outcome analysis included the Foot Function Index, AOFAS score and VAS for pain pre-operatively and post-operatively at the last follow-up. This patient-reported outcome scores were used in the native language of each patient (Italian). Clinical and functional outcomes were collected from 54 patients (28 heels treated by open technique and 26 heels treated by endoscopic technique). In the open group, the AOFAS score improved from a pre-operative value of 65.67 ± 10.09 points to a value of 91.78 ± 9.67 points at the last follow-up (P < 0.05). In the endoscopic group, the AOFAS score improved from a pre-operative value of 66.69 ± 7.19 points to a value of 93.69 points ± 10.04 at the last follow-up (P < 0.05). The VAS and the FFI (Disability and Pain) scores were also improved significantly in both groups at the final follow-up evaluation (P < 0.001). Comparing the final follow-up post-operative clinical scores between the two groups, there was no difference in the AOFAS, VAS or the FFI scores between the two groups. No major complications were recorded, except for one Achilles tendon tear after open calcaneoplasty. The satisfaction rate was similar for both techniques. Both techniques provided good clinical outcomes with a low rate of complications.

Endoscopic Management of Patients with Haglund's Disease: A Prospective Study

Endoscopic Management of Patients with Haglund's Disease: A Prospective Study

Physiotherapy´s protocol to approach the insertional achilles tendinopathy

Background: The Achilles tendinopathy affects to great number of sport people as many elite ones as amateur. Besides, the incidence of this injuries type has increased in an unconscionable way within the last decade caused principally by the impact of amateur sports over the society. It´s common among athletes who play racket sports, athletic, volleyball and football, being one of the most frequently injuried tendons in human beings bodies in spite its strength. This aim of this paper is to present a list of several Haglund disease cases that have been treated by conservative treatment, evaluating the results after 10 sessions by VISA-A scale that evaluates pain, function and sports activity in people suffering of Achilles tendinopathy. Methodology: The study use the clinical´s histories from 5 cases conducted on 5 patients in Spain during 2010 to 2015. The 5 cases were selected from a total of 42 conservative treatment cases done over Achilles tendon. The physiotherapy protocol has been used in all cases consisted in 10 sessions where a combination of several physiotherapy techniques. The patients were evaluated before the first treatment session and after the last one by the VISA-A scale and EVA. Result: After 10 sessions of treatment, the results of the VISA_A show an improvement of 25 % and in case of the EVA scale the pain improvement in 5 points.

Achillean Tendinopathy or Haglund's Disease: Role of PMR. Case Report

Achillean Tendinopathy or Haglund's Disease: Role of PMR. Case Report

Endoscopic calcaneoplasty: five-year results

The aim of this study was to evaluate the results of the endoscopic calcaneoplasty technique for the treatment of retrocalcaneal bursitis and Haglund's disease. This study included 30 feet of 28 patients who underwent endoscopic surgery for Haglund's disease between 2003 and 2011. The inflamed bursa and posterosuperior surface of the calcaneus were removed with a shaver and bone resection performed until there was no friction on the Achilles tendon with the ankle in dorsiflexion. All patients were discharged on the same day and allowed full weight-bearing at the second postoperative week. American Orthopedic Foot and Ankle Society (AOFAS) scores and patient satisfaction were recorded. Average follow-up was 58.4 months. AOFAS scores significantly improved from a postoperative average of 52.6 points to 98.6 points at the final evaluation (p<0.005). All patients were satisfied with the result of the operation. Endoscopic calcaneoplasty with the patient in the prone or supine position appears to be a safe and effective surgical procedure for the treatment of retrocalcaneal bursitis and Haglund's disease.

The “Cello Technique”: A New Technique for Ultrasound-Assisted Calcaneoplasty

The “cello technique” is a new calcaneoplasty technique for the treatment of Haglund disease. It is an ultrasound-assisted technique for resection of the posterosuperior part of the calcaneus. It is possible to resect the posterosuperior part of the calcaneus under direct ultrasound control with the patient in the prone position, with a dorsally positioned ultrasound probe, in line with the Achilles tendon fibers (sagittal line), and with the abrader in the posteromedial working portal. We describe in detail the technique for this new procedure in foot and ankle surgery. This innovative technique offers the possibility of expanding the indications for ultrasound-guided surgery in other fields of orthopaedic surgery.

Achilles tendinitis in Haglund's disease: Role of functional treatment. Report of one case

Achilles tendinitis in Haglund's disease: Role of functional treatment. Report of one case

Minimally invasive retrocalcaneal bursa pressure measurement: development and pilot application

Up to now diagnosis of Haglund's disease is based on patient's history and clinical findings. There is no valid diagnostic tool described to functionally detect retrocalcaneal bursitis. Retrocalcaneal bursa pressure may be increased in these patients. We hypothesized that retrocalcaneal bursa pressure can directly be measured. In this pilot investigation we tested the feasibility of a system which is already in clinical use for arterial blood pressure monitoring to quantitatively assess retrocalcaneal bursa pressure in a human and a swine cadaver specimen and in vivo. Using the presented system retrocalcaneal bursa pressure measurement is demonstrated to be feasible. Moreover, intrabursal pressure is reproducibly and validly quantified. In an uninjured subject increasing ankle dorsiflexion was not associated with increasing pressure in the retrocalcaneal bursa. Experimental liquid injection in the retrocalcaneal bursa was associated with increased intrabursal pressure and increasing pain. Feasibility of the tested setup could be proven. The question, if retrocalcaneal bursitis can be distinguished from further heel pathologies by different pressures in the retrocalcaneal bursa has to be addressed in a subsequent in vivo study.

Validierung des VISA-A-G Fragebogens für deutschsprachige Patienten mit chronischer Bursitis subachillea

The VISA-A questionnaire is currently the only valid, reliable, and disease specific patient administered questionnaire for research in Achilles tendinopathy. To perform multinational and multilingual investigations this instrument was already adapted to several languages. According to the "guidelines for the process of cross-cultural adaptation of self-report measures" we already translated and validated the VISA-A questionnaire for patients with Achilles tendinopathy. To cross-culturally adapt and validate the VISA-A Questionnaire for German-speaking patients suffering from Haglund's disease. The VISA-A-G questionnaire was tested for reliability, validity, and internal consistency in 39 Haglund's disease patients and 79 asymptomatic persons. For concurrent validity the VISA-A-G was compared with the Curwin and Stanish tendon grading system and with the Percy and Conochie classification system for the effect of pain on athletic performance. VISA-A-G results in Haglund's disease were additionally compared with VISA-A-G results obtained from Achilles tendinopathy patients and with VISA-A results presented in the international literature. ICC for the VISA-A-G questionnaire in conservatively treated Haglund's disease patients was 0.96. In asymptomatic students and joggers ICC was 0.97 and 0.60. When correlated with the grading system of Curwin and Stanish and with the Percy and Conochie classification rho was -0.95 and 0.94, respectively. Internal consistency (Cronbach's alpha) for the total VISA-A-G scores of the patients was calculated to be 0.87. Compared with VISA-A-G results obtained from Achilles tendinopathy patients there was no relevant difference discernible. Compared with VISA-A results presented in the original publication no difference was found statistically for students, healthy people, conservative, and preoperative patients, respectively. This study confirms that the VISA-A-G is a valid and reliable measure for German-speaking patients suffering from Haglund's disease.

Surgical Management of Insertional Achilles Tendinopathy with Haglund's Deformity: A Preliminary Report

Purpose: We wanted to report on treatment outcomes in insertional Achilles tendinopathy patients with Haglund's deformity that were operated on using a central achilles tendon splitting approach. Materials and Methods: We enrolled six cases of insertional tendinopathy with concomitant Haglund's disease who underwent an operation between January, 2007 and November, 2008 and for whom follow-up duration for more than 1 year were available. The mean age was 41.5 (21-62) years; the mean follow-up period was 16.3 (12-24) months. Resection of retrocalcaneal bony prominences and inflamed bursa with debridement of degenerative tendons was done using central splitting approach in all cases. A lateral ankle radiograph was used to assess the amount of bony resection. Clinical and functional evaluations were done before and after the operation. Results: In all cases, retrocalcaneal bony prominences were completely resected. Clinical and functional outcomes were significantly improved. One case had a mild tingling distal to the operative lesion. There were no other complications. Conclusion: A central splitting approach is an efficient procedure that can provide sufficient exposure to remove pathologic lesions in patients with insertional Achilles tendinopathy accompanying Haglund's disease.