Introduction:Haglund's syndrome is a deformity of the postero-superior and lateral heel-shaped profile commonly associated with inflammation of the retro-calcaneal bursa and characterized by pain and swelling. Aim of the study was to evaluate the reliability and effectiveness of minimally invasive percutaneous surgical procedure for Achilles tendon decompression. Methods: From January 2014 to April 2016, a total of 21 continuous patients with Haglund's deformity (15 men, 6 women, mean age of 40 years) were enrolled. The regularization of calcaneous profile and borsectomy were performed in all cases. The results were evaluated both clinically with American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS-hindfoot), Visual Analog Scale (VAS) before surgery and at 6 months' follow-up. Radiographic results were also collected using Muscles, Ligaments and Tendons Journal 2018;8 (4):488-494 488 Fowler-Philip before the surgery and one-month follow-up. Results: The average AOFAS-hindfoot score increased from 50.57 to 97. 42 (p<.00001). VAS score decreased from 6.85 to 0.19 (p<.00001) and the mean Fowler-Philip angle decreased from 79,57°t o 53.76°(p<.00001). In our series, no complications were observed and all patients were satisfied at last follow-up. Conclusions: Our results suggest that Achilles decompression by percutaneous approach for painful Haglund's deformity is a reliable and effective surgical procedure. Level of evidence: IV.
Background: Percutaneous operative techniques for hallux valgus (HV) correction are less damaging to soft tissues and the first metatarsophalangeal joint, and they carry a lower risk of wound complications. We report our preliminary results using a percutaneous technique that allowed correction of the deformity without internal fixation. Methods: One hundred ninety-five consecutive patients with isolated symptomatic HV were surgically treated using a percutaneous technique without any form of internal fixation, with a mean follow-up of 34.6 months. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale score was used for clinical assessment. Radiographic evaluation included pre- and postoperative assessment of the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), and sesamoid position in weightbearing radiographs. Results: According to the AOFAS score, the patients improved from a preoperative median of 54.7 to 89.6 at 2 years’ follow-up ( P = .002). Patients were satisfied or very satisfied in 94% of cases at the latest follow-up. A mean radiographic correction of the HVA of 15.5 degrees, of the IMA of 5.4 degrees, and of the DMAA of 5.4 degrees was achieved. The AOFAS global score and every individual parameter improved significantly between pretreatment and latest follow-up ( P > .01). A total of 19 (9.7%) complications were reported. Conclusion: This percutaneous technique, which did not use any form of internal fixation described, produced durable results for the correction of HV, reliably correcting the deformity and resulting in significant improvement in function and decrease of pain. Level of Evidence: Level IV, retrospective case series.
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