Dorsal closing wedge calcaneal osteotomy for the treatment of Insertional Achilles Tendinopathy: A technical tip to optimize its results and reduce complications

Georgiannos, Dimitrios; Kitridis, Dimitrios; Bisbinas, Ilias

doi:10.1016/j.fas.2016.12.004

“…Additionally, less bone fixation necessitates less obtrusive surgery. Georgiannos et al performed a similar osteotomy as we did; they used K-wire to persevere the plantar bone-hinge [24] and showed good clinical outcomes in 64 feet of athletes [11].…”

Section: Discussionmentioning

confidence: 78%

Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

Ge

¹

,

Ma

²

,

Hong

³

et al. 2020

Preprint

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Background: Haglund syndrome is a common disease that causes posterior heel pain. This study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence resection (PPR) for the treatment of Haglund syndrome.Methods: This retrospective study included 12 patients who underwent DCWCO and 32 patients who underwent PPR from January 2010 to August 2016. Patients were evaluated using the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler's angle, and calcaneal pitch angle preoperatively and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up).Results: Both groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery.The DCWCO group had lower AOFAS scores than the PPR group at 6 months (77.6 ± 5.1 vs. 82.8 ± 7.8; P =0.037) but had higher scores at the latest follow-up (98.2 ± 2.3 vs. 93.4 ± 6.1; P =0.030). The DCWCO group had lower VISA-A scores at 3 months (56.9 ± 13.9 vs. 65.2 ± 11.0; P =0.044) but higher scores at the latest follow-up (98.2 ± 2.6 vs. 94.3 ± 5.0; P =0.010) than the PPR group. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler's angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group (35.9°± 4.9° vs. 31.4° ± 6.2°; P =0.026). However, there was no statistically significant difference in any other angle of the two groups postoperatively.Conclusions: Compare to PPR group, the DCWCO group had poorer short-term clinical outcomes but provide better long-term function and symptom remission. This method can be a good option for those patients with higher functional expectations. BackgroundHaglund deformity, first described by Patrick Haglund in 1928, is a prominence in the posterolateral heel that causes posterior heel pain [1]. It is generally associated with insertional Achilles tendinopathy (IAT) and retrocalcaneal bursitis, which comprise the Haglund triad or Haglund syndrome [2,3]. Surgical intervention is a suitable option when conservative treatment for more than 6 months has failed [4]. Common surgical methods, including posterosuperior prominence resection 4 (PPR), retrocalcaneal decompression, and endoscopic treatment, generally have good short-term clinical outcomes [5,6]. However, a few patients still experience some degree of pain after surgery, especially after PPR [7]; therefore, another surgical method is required for better outcomes.Dorsal closing wedge calcaneal osteotomy (DCWCO) was first described by Zadek for the treatment of IAT [8]. Keck and Kelly proved that DCWCO was an effective treatment for Haglund deformity in 18 patients [9]. Further, Miller reported that wedge osteotomy of the calcaneus body combined with resection of the superior calcaneus showed good results in 16 patients (18 feet) [10]. Dimitrios treated IAT with dorsal wedge calcaneal osteotomy in 52 athletes, al...

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“…In addition, less bone fixation required a more discreet operation. Georgiannos performed a similar osteotomy as we did; they used K-wire to persevere the plantar bone-hinge [22] and showed good clinical outcomes in 64 athletes' feet [9]. Both methods provided are options to perform this surgery with less complications and more reproducibility.…”

Section: Discussionmentioning

confidence: 87%

Comparison of a dorsal closing wedge calcaneal osteotomy versus a posterosuperior prominence resection for the treatment of Haglund syndrome

Ge

¹

,

Ma

²

,

Hong

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Haglund syndrome is a common disease that causes posterior heel pain. The objective of this study was to compare the clinical outcomes between the dorsal closing wedge calcaneal osteotomy (DCWCO) and the posterosuperior prominence resection (PPR) for the treatment of this disease. Methods The retrospective study included 12 patients who received DCWCO and 32 who patients received PPR from January 2010 to August 2016. The patients were evaluated in terms of the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), the Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), the Fowler-Philip angle, Bohler’s angle, and the calcaneal pitch angle, both pre- and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up). Results Both groups showed a significance increase in their AOFAS and VISA-A scores after the operation. The DCWCO group showed a lower AOFAS score than the PPR group after 6 months (77.6 ± 5.1 vs. 82.8 ± 7.8, P =0.037), but received higher scores in the latest follow-up (98.2 ± 2.3, vs. 93.4 ± 6.1, P =0.030). For the VISA-A scores, the DCWCO group had lower scores for 3 months (56.9 ± 13.9, vs. 65.2 ± 11.0, P =0.044), but showed higher scores in the latest follow-up (98.2 ± 2.6, vs. 94.3 ± 5.0, P =0.010) when compared with the PPR group. Both groups had a significant change in the Fowler-Philip angle and Bohler’s angle after the operation. The postoperative Fowler-Philip angle in the DCWCO group was greater than that of the PPR group (35.9° ± 4.9°, vs. 31.4° ± 6.2°, P =0.026). However, there was no statistical difference in any other angle between the two groups, postoperatively. Conclusions The DCWCO group had poorer short-term clinical outcomes but better long-term function and symptom remission, as compared with the PPR group, in the treatment of Haglund syndrome.

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“…Additionally, less bone fixation necessitates less obtrusive surgery. Georgiannos et al performed a similar osteotomy as we did; they used K-wire to persevere the plantar bone-hinge [24] and showed good clinical outcomes in 64 feet of athletes [11]. Maffulli et al coupled a resection of the posterosuperior corner of the calcaneus with a dorsally based closing wedge osteotomy of the calcaneus, placed more posterior to the one we undertook, without debriding the insertion of the Achilles tendon, with significant functional improvement at 2 years after the procedure [25].…”

Section: Discussionmentioning

confidence: 92%

Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

Ge

¹

,

Ma

²

,

Tang

³

et al. 2020

View full text Add to dashboard Cite

Background: Haglund syndrome is a common disease that causes posterior heel pain. This study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence resection (PPR) for the treatment of Haglund syndrome. Methods: This retrospective study included 12 patients who underwent DCWCO and 32 patients who underwent PPR from January 2010 to August 2016. Patients were evaluated using the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler's angle, and calcaneal pitch angle preoperatively and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up). Results: Both groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery. The DCWCO group had lower AOFAS scores than the PPR group at 6 months (77.6 ± 5.1 vs. 82.8 ± 7.8; P = 0.037) but had higher scores at the latest follow-up (98.2 ± 2.3 vs. 93.4 ± 6.1; P = 0.030). The DCWCO group had lower VISA-A scores at 3 months (56.9 ± 13.9 vs. 65.2 ± 11.0; P = 0.044) but higher scores at the latest follow-up (98.2 ± 2.6 vs. 94.3 ± 5.0; P = 0.010) than the PPR group. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler's angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group (35.9°± 4.9°vs. 31.4°± 6.2°; P = 0.026). However, there was no statistically significant difference in any other angle of the two groups postoperatively. Conclusions: Compared to the PPR group, the DCWCO group had poorer short-term clinical outcomes but provide better long-term function and symptom remission. This method can be a good option for those patients with higher functional expectations.

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Dorsal closing wedge calcaneal osteotomy for the treatment of Insertional Achilles Tendinopathy: A technical tip to optimize its results and reduce complications

Cited by 18 publications

References 11 publications

Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

Comparison of a dorsal closing wedge calcaneal osteotomy versus a posterosuperior prominence resection for the treatment of Haglund syndrome

Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

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