Walking Boot Research Articles

Talonavicular arthrodesis

Realignment of the hindfoot by talonavicular arthrodesis. Idiopathic and posttraumatic arthritis of the talonavicular joint with or without malalignment. Optional in flatfoot reconstruction. General medical contraindications to surgical interventions. Medial, dorsomedial, or dorsal skin incision. Exposure of the talonavicular joint and cartilage removal. Decortication. Reposition of the joint if malaligned. Optional transplantation of corticocancellous bone. Temporary stabilization with Kirschner wires and stabilization with screws, optional with cramps or plates. Sixweeks nonweightbearing in along walker boot. Afterwards 2weeks of progressively weight bearing in along walker boot. Then full weightbearing in walking shoes with stiff soles. Physiotherapy. Atotal of 18feet in 18patients with isolated talonavicular arthritis were treated with isolated talonavicular fusion and corticocancellous bone thorough amidline incision. For postoperative management, patients had nonweightbearing for 6weeks in along walker boot. Mean follow-up was 14.5months (range 8-35months). Mean age was 63.2years (range 54-72years). Preoperative Manchester-Oxford Foot Questionnaire (MOXFQ) score was 65.3 (± 5.2); postoperative MOXFQ score was 28.5 (± 7.0). One revision surgery performed due to pseudarthrosis.

Medial sleeve fractures in elite-athletes: A heterogeneous group, anatomical and case-based considerations.

The purpose of this study is to provide a detailed description of the anatomy and radiology of the medial sleeve and present an approach in its management among elite athletes. Five cases of elite athletes who underwent treatment for a medial sleeve injury of which the diagnosis was confirmed through physical examination and additional magnetic resonance imaging scan are described in this study. Two patients presented with isolated medial sleeve injuries, while the other three patients suffered from concomitant ankle injuries. Non-operative treatment consisted of relative rest, soft cast immobilization and mobilization in a walking boot or kinesiotape which was successful in four of the cases with regard to the medial sleeve. One patient underwent surgery due to syndesmotic instability. Another patient presented with combined medial and lateral ankle instability which was treated surgically with an open medial and lateral ligament repair. All patients were able to return to their pre-injury sports and at the time of the last follow-up were still playing in their pre-injury level of competition. Medial sleeve injuries of the ankle in elite athletes should be considered in the differential diagnosis for athletes presenting with medial ankle pain. Inherent knowledge regarding anatomy is essential when guiding the management of these injuries which can be treated successfully with a non-operative approach consisting of relative rest, immobilization, kinesiotape and physical therapy. In case of persistent medial instability or rotational instability, surgical repair is a viable treatment option. Both modalities allow athletes to return to the pre-injury level of competition. However, early diagnosis is crucial to minimize the delay of appropriate treatment and avoid potential residual symptoms. Level IV.

Clinical Outcomes of Talus Bone Marrow Edema: Comparing Plaster Cast, Crutches, and Walking Boot Treatments.

BACKGROUND Bone marrow edema (BME) basically involves localized hemorrhage and subtle compression fracture within the bone. We compared outcomes of 70 patients with traumatic BME of the talus, treated with a plaster cast, crutches, or walking boot. MATERIAL AND METHODS MRIs diagnosed 70 patients with talus BME who were randomly assigned into 3 groups of different treatments: Group 1 (n=33) patients were treated with plaster cast's Group 2 (n=21) patients used crutches, and Group 3 (n=16) patients used walking boots. The outcome variables were AOFAS and VAS scores. RESULTS No significant difference was demonstrated in the pre-treatment AOFAS scores between the groups (P>0.05). The AOFAS scores differed significantly after treatment, with Group 2 had the greatest increase in scores (P=0.002) and significantly higher AOFAS scores compared to Group 1 (100 [79-100] vs 94 [75-100], P=0.001). No significant difference was found in pre-treatment VAS scores between the groups (P=0.007). The post-treatment VAS scores were significantly reduced, especially for Group 2. Within-group analysis demonstrated a significant decrease of VAS scores for all groups (P<0.001). CONCLUSIONS Use of non-weight-bearing crutches for 3 weeks had better clinical results than use of a plaster cast when treating talus traumatic bone marrow edema. This was reflected in higher AOFAS and VAS, suggesting use of crutches is associated with better pain management and improved function.

Toddler’s fracture: an updated guide on evaluation and management

Toddler’s fractures are commonly encountered in pediatric healthcare. These injuries are associated with little to no risk of fracture displacement or failure to heal, regardless of treatment modality. The standard treatment for these injuries has historically been several weeks of weightbearing restriction and immobilization in a circumferential cast or posterior splint. Over the last decade, numerous reports comparing clinical outcomes and iatrogenic complication rates between treatment modalities have emerged, revealing a concerning trend of higher rates of skin breakdown in patients treated with traditional management compared to those treated with removable walking boot immobilization or no immobilization. Current management practices for toddler’s fractures vary widely with respect to both initial and follow-up care, reflecting a need for additional guidance on this topic. This review provides an updated, evidence-based review of evaluation and management strategies for the toddler’s fracture.

Short term temporal outcomes after intramedullary fixation of lateral malleolus fractures

Ankle fractures are a common intra-articular trauma. The gold standard treatment for unstable ankle fractures has been Open Reduction Internal Fixation with plating and lag screw(s). Advocates for intramedullary nailing of the fibula note decreased wound complications and greater biomechanical strength. We hypothesized that time to union and time to weight bearing would be decreased with a fibular intramedullary nail compared to prior ankle ORIF literature. A retrospective cohort study was conducted of 65 consecutive ankle fracture patients treated with a fibular nail. The median follow-up time was 18.3 months (IQR: 55.4 – 97.6 days). All patients (100%) achieved clinical and radiographic union at a median of 9.6 (IQR: 54 – 78 days) and 10.8 weeks (IQR: 58 – 95 days), respectively. Post-operatively patients bore weight in walking boot and athletic shoe at a median 6.1 and 9.4 weeks, respectively. Fifteen patients suffered complications (23.1%). Patients with history of prior or active smoking were significantly correlated to longer time to union (p=0.016). Time to union also took 0.43 days longer for each additional year of age (t-value 2.13, p-value = 0.038). Nineteen out of 65 patients (29.2%) participated in the Olerud-Molander Ankle Scoring and the median functional outcome score was 71 (IQR: 56 – 93). While fibular nailing has advanced passive range of motion and weight bearing in our institution, time to weight bearing is clouded by surgeon comfort. Further study comparing fibular fracture healing and weight bearing status in regards to intramedullary and plate fixation in needed. Level of EvidenceIV

Surgical Intervention of a Fibular Stress Fracture in a Male Basketball Player: A Case Report

This is a case of a 21-year-old male, African American Division I basketball player with a fibula stress fracture. The athlete initially reported pain, without distinct injury and was diagnosed with a stress fracture. After a short period of immobilization in a walking boot, this individual opted to undergo surgical intervention consisting of an intramedullary screw inserted in his left fibula. This was in consultation with the orthopedic team physician and orthopedic trauma surgeon. After a brief period of rest and continued immobilization in a walking boot, weight bearing as tolerated, the patient was able to start rehabilitation. He continued rehabilitation and progressive return to activity and was able to return to limited practice approximately 4 weeks. He played 13 min of a game in under 5 weeks (31 days). Stress fractures are not uncommon in basketball players, but a fibula stress fracture is one not often seen, and there is a paucity of data in the literature regarding this injury. A nonoperative approach to treatment of a fibula stress fracture typically yields good results but may lead to longer return than a surgical intervention. Providing athletes options for treatment may result in a quicker recovery. This case demonstrates a novel treatment option resulting in a quicker return to play.

Prediction of Recurrent Lateral Ankle Sprain and Ankle Pain Using Applied Care Strategies and Patient-Reported Outcomes.

Lateral ankle sprain (LAS) patients often have deficient patient-reported outcomes (PROs) at return-to-activity (RTA), potentially increasing risk for recurrent LAS and ankle pain. Additionally, applied care strategies are known to correct impairments, but their ability to mitigate risk for long-term consequences remains unknown. To determine if applied care strategies and PRO scores at RTA and 6-months post-RTA predict recurrent LAS and ankle pain 12 months after an acute LAS. Prospective cohort study. Online survey. We enrolled 63 individuals within one week of sustaining an acute LAS. Participants completed online surveys about their health history and recent LAS. At RTA and 6 months post-RTA, participants completed online surveys regarding demographics, applied care strategies, and patient reported outcomes (PROs): Foot and Ankle Disability Index, Identification of Functional Ankle Instability, Godin Leisure-Time Exercise Questionnaire, Short Form-8. At 12 months post-RTA, we asked participants if they sustained recurrent LAS. Chi-squares determined if recurrent LAS and ankle pain at 12-months were related to applied care strategies or ankle pain at RTA. Independent t-tests compared demographics and PROs at RTA and 6-months between participants with and without a recurrent LAS or ankle pain at 12-months. Logistic regression and area under the receiver operating characteristic (AUROC) analyses determined if demographics, applied care strategies, ankle pain at RTA, and PRO scores at RTA and 6-months predicted recurrent LAS and ankle pain at 12-months. Participants with a recurrent LAS had a lower walking boot use (P=0.05) and were taller than those without (P=0.03). Increased height and lack of walking boot use were predictive of recurrent LAS (P<0.01, R2=0.33, AUROC=0.81[0.68, 0.95]). LAS patients who are taller and do not use a walking boot might have greater risk for a recurrent LAS withing 12 months of RTA.

Feasibility of an early progressive resistance exercise program for acute Achilles tendon rupture

BackgroundLong-term strength deficits are common after Achilles tendon ruptures. Early use of progressive resistance exercises may help reduce strength deficits, but the feasibility of this approach is unknown. The aim was to investigate the feasibility of early progressive resistance exercises regarding patient acceptability and compliance with the intervention.MethodsWe recruited patients with an acute Achilles tendon rupture treated non-surgically. During 9 weeks of immobilisation with a walking boot, participants attended weekly supervised physiotherapy sessions of progressive resistance exercises and performed home exercises, consisting of isometric ankle plantarflexion, seated heel-rise, and elastic band exercises. Acceptability was evaluated using a 7-point Likert scale (1 = very unacceptable and 7 = very acceptable) with feasibility threshold at 80% of the participants rating ≥ 4. Adherence to the exercises was defined as 80% of the participants performing at least 50% of the home exercises. During the intervention, tendon healing and adverse events were monitored.ResultsSixteen participants (mean age 46 (range 28–61), male/female = 13/3) completed the intervention. Pre-injury Achilles tendon total rupture score was 98 (SD 8). All participants rated the acceptability of the exercises ≥ 5 (moderate acceptable to very acceptable) at 9- and 13-week follow-up and 9/16 rated 7 points (very acceptable). Participants performed 74% (range 4–117) of the total prescribed home exercises and 15/16 performed > 50%. One participant was not compliant with the home exercises due to feeling uncomfortable performing these independently. There were no re-ruptures, but one case of deep venous thrombosis.ConclusionsThe early progressive resistance exercise program for treatment of non-surgically treated Achilles tendon rupture was feasible. Future studies should investigate the efficacy of the progressive intervention.Trial registrationThe study was registered at Clinical Trials (NCT04121377) on 29 September 2019. ClinicalTrials: NCT04121377.

How does orthotic walker boot design influence lower limb and trunk function during gait?

Background: Undesirable lower limb gait deviations have previously been reported when wearing orthotic walker boots; therefore, there is a need to optimize orthotic walker boot designs to facilitate normal gait. Objective: This study explored the biomechanical effects of 2 designs of orthotic walker boot on the lower limb and trunk compared with usual footwear. Study design: A repeated measures analysis of variance was used to evaluate selected kinematic and kinetic variables under different walking conditions. Methods: Sixteen healthy participants walked in 3 conditions using: Walker A (Airselect Elite, Enovis), Walker B (Townsend XLR8 Series Walker, Thuasne, France), and a usual shoe. A 10-camera motion analysis system and 4 force plates were used to collect kinematic and kinetic data. Results: Gait speed was significantly slower in both orthotic walker boots, and there was significantly decreased ankle range of motion, which is their primary function. Significant deviations in normal knee and hip kinematics and kinetics, shank-to-vertical angle, and pelvic and trunk movements were noted with both walker boots, with the greatest deviations from the shoe condition observed in Walker B. Recline and incline shank angular velocities showed the greatest differences in Walker B, which could be associated with adverse knee joint moments and a significantly greater perceived ease of walking in Walker A. Conclusions: Orthotic walker boot design significantly affects walking mechanics. Orthotic walkers with greater forefoot rocker profiles and inclined vertical shank angles may at least partly mitigate known gait deviations when wearing orthotic walkers.

Chronic Achilles Tendon Avulsion Repair: Central Third Fascia Slide Technique with Flexor Hallucis Longus Transfer.

Chronic Achilles Tendon Avulsion Repair: Central Third Fascia Slide Technique with Flexor Hallucis Longus Transfer.

Immediate Unprotected Weightbearing vs 2 Weeks Nonweightbearing After Open Reduction Internal Fixation of Ankle Fractures.

Postoperative care protocols for ankle fracture surgery remain controversial with variability among care providers. This prospective controlled trial compared 12-week postoperative outcomes for immediate unprotected weightbearing (IMWB) vs nonweightbearing (NWB) for 2 weeks in a splint followed by weightbearing as tolerated (WBAT) in a boot after surgical fixation of selected low-energy ankle fractures without superior articular involvement. Eighty-seven patients undergoing surgical fixation of ankle fractures at a single level 1 trauma center were recruited according to specific criteria and enrolled by presentation date. The first 43 eligible patients were allocated to the control group, with NWB in a splint for 2 weeks followed by WBAT in a walker boot. The next 44 patients recruited were allocated to the IMWB group. The primary outcome was the Olerud-Molander score (OMAS). Secondary outcome measures included the Euroquol-5D (EQ5D) score and Work Productivity and Activity Impairment: Specific Health Problem (WPAI:SHP) scores, ankle range of motion (ROM), wound complications, time to return to work, radiograph measurements, and fracture reduction loss. In this perioperative-focused study, we collected data on patients until 12 weeks postoperation. The IMWB group had 5 superficial wound complications vs 1 in the control group. At 12 weeks, we found no difference in OMAS, EQ5D, WPAI:SHP scores, ROM, time to return to work, or radiographic measurements. In this short-term and relatively small prospective trial, we found more wound complications among patients treated with immediate unprotected weightbearing compared with patients treated with 2 weeks of NWB followed by protected weightbearing. Given the low incidence and small sample size, we do not know if these observed findings are generalizable. However, we also found no difference in functional outcomes at 12 weeks postoperation between these 2 groups. In light of that, we do not recommend IMWB after open reduction internal fixation of low-energy ankle fractures with plate and/or screw fixation. Level II, prospective controlled trial.

DEALING WITH INJURED OR REPAIRED ANKLES IN OLDER ADULTS: ASSESSING ANKLE IMMOBILIZATION METHODS DURING LOCOMOTION

Abstract Orthopedic walking boots (OWB) are an alternative to casting and immobilizing an injured ankle. Unfortunately, OWB causes a change in leg-length and pelvis angle which alters gait and postural stability and can lead to chronic back pain. Immobilizing the ankle without changing leg-length would be beneficial, especially for individuals with impaired gait and postural stability. The purpose of this study was to assess level-ground walking and stair negotiation in healthy older adults across three ankle support conditions (1) OWB, (2) TayCo ankle brace (TAB) and (3) athletic footwear (SHOD). Sixteen older adults (69+/-7.0 years) performed 2-3 trials of walking, stair ascent, and stair descent using each of the three ankle support conditions. Ankle motion in all three planes was monitored using 3D motion capture cameras to assess differences during walking and stair negotiation. For all tasks, significant differences were revealed between the SHOD and both ankle support methods for all three planes (p &amp;lt; .001). Significant differences were also revealed between OWB and TAB during walking in the transverse plane (abd/adduction) (p = .036 OWB&amp;gt;TAB) and for stair descent in the sagittal plane (dorsi/plantarflexion) (p = .001 TAB&amp;gt;OWB). No other differences were observed between the OWB and TAB for walking or stair negotiation. Ankle motion was similarly controlled with both the OWB and TAB indicating that either method would be appropriate to immobilize an injured ankle, however the TAB does not alter leg length or pelvic tilt since it fits over the individual’s footwear.

Acute biomechanical responses to wearing a controlled ankle motion (CAM) Walker boot during walking

BackgroundControlled ankle motion (CAM) boots are often prescribed during the rehabilitation of lower limb injuries and pathologies to reduce foot and ankle movement and loading whilst allowing the patient to maintain normal daily function. Research questionThe aim of this study was to quantify the compensatory biomechanical mechanisms undergone by the ipsilateral hip and knee joints during walking. In addition, the compensatory mechanisms displayed by the contralateral limb were also considered. MethodsTwelve healthy participants walked on an instrumented treadmill at their preferred walking speed. They underwent kinematic and kinetic analysis during four footwear conditions: normal shoes (NORM), a Malleo Immobil Air Walker on the right leg (OTTO), a Rebound® Air Walker on the right leg with (EVEN) and without (OSS) an Evenup Shoelift™ on the contralateral leg. ResultsCAM boot wear increased the relative joint contribution to total mechanical work from the ipsilateral hip and knee joints (p < 0.05), which was characterised by increased hip and knee abduction during the swing phase of the gait cycle. EVEN increased the absolute work done and relative contribution of the contralateral limb. CAM boot wear reduced walking speed (p < 0.05), which was partially compensated for during EVEN. SignificanceThe increased hip abduction in the ipsilateral leg was likely caused by the increase in effective leg length and limb mass, which could lead to secondary site complications following prolonged CAM boot wear. Although prescribing an even-up walker partially mitigates these compensatory mechanisms, adverse effects to contralateral limb kinematics and kinetics (e.g., elevated knee joint work) should be considered.

Prospective randomized controlled trial: early weight bearing after conservative treatment of Weber B ankle fractures (pancake trial)

PurposeDifferent studies have shown that weightbearing is safe in stable transsyndesmotic, isolated lateral simple ankle fractures. Despite this evidence, AO guidelines still recommend immobilization with above-the-knee cast for 4–6 weeks for these fractures. The objective of this study was to compare the outcomes of mobilization and weightbearing to those of immobilization and non-weightbearing in patients with stable transsyndesmotic, lateral isolated simple ankle fractures.MethodsFifty patients were randomly assigned to permissive weightbearing in a walking boot or non-weightbearing immobilization using a below-the-knee cast. Primary outcome was ankle functionality as scored by the Olerud-Molander Ankle Score (OMAS). Secondary outcomes were radiological displacement of fracture, range of motion (ROM), calf circumference, and RAND 36-item health survey. Patients were in follow-up for 24 months.ResultsAnkle functionality after six and twelve weeks was significantly higher for the intervention group, with respectively 30 points (p = 0.001) and 10 points (p = 0.015) of difference. ROM improved significantly in the intervention group after six weeks. All fractures showed radiological progression of fracture healing. RAND 36-item showed differences in both physical (60.3 vs. 46.3, p = 0.017) and mental (78.5 vs. 58.2, p = 0.034) components in favor of the intervention group. In 16% of patients who initially showed stable fractures on radiographic imaging, joint dislocation was identified on weightbearing radiographs prior to randomization, leading to exclusion.ConclusionWeightbearing and mobilization using a walking boot may be a safe treatment for patients with stable Weber B fractures.

916 Introducing a New Guideline for the Fifth Metatarsal Fracture (5th MTF)

Abstract Background The 5th MTF is a common injury occurring in the long bone joining the ankle to the toes. This injury can be categorised into two main sub-sections, namely green zone fractures (GZF) and red zone fractures (RZF) which are treated differently. Moreover, patients suffering from uncomplicated GZF are to be discharged directly from emergency department (ED), whereas the complex cases require a review from orthopaedic doctors. Due to time-restraint in ED, some fractures might be misdiagnosed/referred directly to fracture clinics unnecessarily. Aim Increase ED-led management and discharge of patients suffering from GZF Method A QI was introduced to implement a new guideline and update the patient information leaflet in the emergency department at ELHT. For each set of baseline data, an intervention was suggested to achieve the goal of this project and ensure a safe discharge of patients from ED. Results During a four-week study period, 20 patients presented to ED with an uncomplicated green zone fracture, 40% of which were discharged directly from ED. This demonstrates an improvement of 12.7% from a baseline of 27.3%. In addition, 80% of these patients were managed with a walker boot, as mentioned in the new guideline. In total, only three fracture clinic appointments were booked, due to complications, as opposed to twenty appointments. This resulted in a saving of £1.835,4. Conclusions The new guideline has led to an improvement of 50% in patient care. The new management plan benefits patients and improves the efficacy of the ED as well as fracture clinics.

1135 Evaluation of Management of Fifth Metatarsal Fractures in University Hospitals of North Midlands Fracture Clinics from March to May 2021

Abstract Aim The primary objective is to ascertain if fracture clinic follow-up of simple, isolated fifth metatarsal fractures is required, or if discharging patients from Accident &amp; Emergency and Minor Injury Units with clinical advice and a contact number is a safe, cost-effective alternative. We also aim to design a protocol and treatment pathway to enable safe discharge and patient-initiated follow-up (PIFU) where required. Method All patients with metatarsal fractures between March and May 2021 had their radiographs, e-records and clinic letters retrospectively reviewed with a one-year follow up. Patients with neuropathy, open fractures and polytrauma patients were excluded. The remaining patients with simple, isolated fifth metatarsal fractures were evaluated. Results 75 patients with an isolated fifth metatarsal fracture were reviewed across three months, with 165 appointments dedicated to them (in person and via telephone). 72% were treated with a metatarsal shoe and 17.3% with a walker boot. One patient required surgery for non-union. £12,018 was spent by the trust for the above appointments, either in person (£152 per unit) or via telephone (£20 per unit). Conclusions Simple, isolated fifth metatarsal fractures should be discharged directly from A&amp;E in a metatarsal shoe with an information leaflet and PIFU. Neuropaths, open fractures or polytraumas should follow a referral protocol which has been designed for our department based on our findings.

Effect of crutch and walking-boot use on whole-body angular momentum during gait

ABSTRACT Crutches are the most prescribed ambulatory assistive device and are used for mobility and maintaining weight-bearing restrictions after injury or surgery. However, standard axillary crutches (SACs) can lead to overuse and other injuries and restrict upper limb movement. Hands-free crutches (HFC) do not restrict upper limb movement but their effect on balance control, with or without commonly prescribed walking boots, is poorly understood. The purpose of this study was to compare the effect of crutch type (SACs vs. HFC) and boot use on whole-body angular momentum (RAM), a measure of balance control. Participant’s balance confidence, pain, comfort, and device preference were assessed. Seventeen participants were evaluated while walking without a crutch (NONE), with SACs, and with an HFC, and walked with and without a walking boot in each crutch condition. The gait pattern used with SACs resulted in significantly greater limb angular velocity (p < .05), and an 84% increase in RAM (p < .001) as compared to the HFC. There were no differences between the SAC and HFC for balance confidence, pain, or comfort, however most (71.1%) participants preferred the HFCs. These results suggest that individuals can better control angular momentum with the HFCs and thus may be less susceptible to loss of balance.

Experience of patients and physiotherapists within the AFTER pilot randomised trial of two rehabilitation interventions for people aged 50 years and over post ankle fracture: a qualitative study

ObjectivesTo explore patient and staff experience of best-practice rehabilitation advice (one session of face-to-face self-management advice with up to two additional optional sessions) compared with progressive functional exercise (up to...

A Dynamic Ankle Orthosis Reduces Tibial Compressive Force and Increases Ankle Motion Compared to a Walking Boot.

Tibial bone stress injuries are a common overuse injury among runners and military cadets. Current treatment involves wearing an orthopedic walking boot for three to twelve weeks, which limits ankle motion and leads to lower limb muscle atrophy. A Dynamic Ankle Orthosis (DAO) was designed that provides a distractive force that offloads in-shoe vertical force and retains sagittal ankle motion during walking. It remains unclear how tibial compressive force is altered by the DAO. This study compared tibial compressive force and ankle motion during walking between the DAO and an orthopedic walking boot. Twenty young adults walked on an instrumented treadmill at 1.0 m/s in two brace conditions: DAO and walking boot. 3D kinematic, ground reaction forces, and in-shoe vertical force data were collected to calculate peak tibial compressive force. Paired t-tests and Cohen's d effect sizes were used to assess mean differences between conditions. Peak tibial compressive force (p = 0.023; d = 0.5) and Achilles tendon force (p = 0.017; d = 0.5) were moderately lower in the DAO compared to the walking boot. Sagittal ankle excursion was 54.9% greater in the DAO compared to the walking boot (p = 0.05; d = 3.1). The findings from this study indicated that the DAO moderately reduced tibial compressive force and Achilles tendon force and allowed more sagittal ankle excursion during treadmill walking compared to an orthopedic walking boot.

Reinsertion of the Achilles Tendon with Bony Anchor in Insertional Achilles Tendinitis with Haglund’s Deformity

Haglund’s deformity is a common cause of hindfoot pain in adults and functional disability. Conservative treatment is effective often. Surgery is required only in intractable cases. Many surgical treatments in a Haglund deformity have been described. After resect and debridement, an anchor suture may use to reattach Achille’s tendon. This study aims to show the place of the suture anchor to improve the reinsertion of the Achilles tendon in an insertional Achilles tendinitis and Haglund’s deformity. We report a 54-year-old male complains of 2 years of chronic right heel pain while strength training. A focused exam of the left ankle showed a bump on the posterior heel with inflammation to the anterior and posterior Achilles tendon. A lateral X-ray and CT scan of the left ankle showed a bone spur and intratendinous calcification of the Achilles tendon with the Philip – Fowler angle at 87°. The Bohler’s ankle was at 27°. After the failure of at least 6 months of conservative treatment, surgical management was indicated. It has consisted of a midline incision. Bursectomy and, resection of the posterosuperior tuberosity of the calcaneus was performed. Then, debridement of necrotic tissue and calcifications in the tendon and any posterior osteophytes were carried out. The tendon had been reinserted at its central part with single-row anchor. The lower leg was immobilized in 20° plantar flexion, this was switched to a walking boot with adjustable plantar flexion. Partial support was allowed at the 6th postoperative week. Full rehabilitation was prescribed after the removal of the cast. At 2-year follow-up, the patient is very satisfied and had no pain when standing on the toes of the operated leg. Dorsiflexion was symmetric. The effective return to full-sport activities was at 6 months at the same level.