Satisfactory Functional Outcome and Significant Correlation with the Length of Haglund’s Deformity after Endoscopic Calcaneoplasty: A Minimum 4-Year Follow-Up Study

Abstract

Background. Haglund’s syndrome is a posterosuperior calcaneal prominence with posterior heel pain causing functional disability to the patient. Operative treatment is indicated after failure of conservative measures and includes resection of the bony hump along with retrocalcaneal bursectomy. This study aimed to evaluate the functional outcome and degree of patient satisfaction after endoscopic resection of Haglund’s deformity with assessment of correlation with the length of bony exostosis. Methods. Seventeen patients (21 feet) with a mean age of 44.7 ± 5.1 years were included in this study. Six females and 11 males underwent endoscopic calcaneoplasty. Clinical outcome evaluation included the assessment of the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society score (AOFAS). The preoperative and postoperative lengths of bony exostosis were measured radiologically. The paired t test and the Wilcoxon signed-rank test compared the preoperative and final postoperative means. P < 0.05 was considered statistically significant. Results. The mean follow-up period was 56.4 ± 5.1 months. Statistically significant improvements in the preoperative mean of AOFAS (from 55.7 ± 9.3 to 94.3 ± 7.1) and VAS (from 8.1 ± 1.4 to 0.7 ± 1.04) at the final follow-up were noted P < 0.0001 . There was a statistically significant correlation between clinical scores (AOFAS and VAS) and the final postoperative length of the bone above parallel pitch lines (PPLs). The patients were satisfied and returned to their previous activities without reporting major morbidities except one patient who had mild pain with exertion. Conclusion. Endoscopic calcaneoplasty is a safe, less invasive surgical procedure for the management of Haglund’s syndrome after failure of conservative treatment. It provided a satisfactory clinical result without serious complications at a minimum 4-year follow-up.

Minimally Invasive Approaches to Haglund’s Deformity and Insertional Achilles Tendinopathy: A Contemporary Review

“…3 , 75 Complications particular to endoscopic and percutaneous procedures are low but still include skin burns, sural nerve injury, nonunion, and inflammation. 11 , 18 Additional risks of the percutaneous Zadek osteotomy include sural nerve damage, plantar fasciitis, nonunion, malunion, hardware failure, hardware irritation, and persistent pain. These complications were observed in only a small percentage of patients (average 6.6% across reported studies), which was slightly lower compared with open procedures (7.9%).…”

“…Traditional open procedures for HD and IAT have relatively good outcomes; however, longer recoveries combined with complications such as wound issues and infections have resulted in the expansion of MIS approaches to treat these pathologies. Although the first generation of MIS techniques involved endoscopic surgery, 5 , 11 , 13 - 15 , 17 , 18 , 24 , 27 , 33 , 35 , 50 , 53 - 55 , 70 , 73 , 74 percutaneous approaches are now gaining momentum. The current work reviews these techniques including endoscopic calcaneoplasty (Haglund resection), percutaneous Haglund resection, and percutaneous Zadek (dorsal closing wedge) calcaneal osteotomy.…”

“…Although this procedure is considered an effective approach to HD and IAT correction, multiple complications have been described, including impaired wound healing, sural nerve injury, wound tenderness, shoe wear irritation, infection, pain, prolonged recovery time, and skin sensitivity. 11 , 13 , 18 , 25 , 33 , 50 , 53 , 56 , 59 , 71 This has led many to adopt minimally invasive approaches to treat HD and IAT. Those in support of MIS approaches cite less pain, better outcomes, quicker return to activity, and increased patient satisfaction.…”