Surgical Treatment of Haglund’s Deformity: A Systematic Review and Meta-Analysis

Abstract

Posterosuperior calcaneal prominence, also known as Haglund's deformity, can often lead to retrocalcaneal bursitis, a significant cause of posterior heel pain. Surgery is indicated for symptomatic patients, after a period of conservative treatment including analgesia, physiotherapy, activity, and shoe wear modification has failed. Surgical options include both open and endoscopic techniques, and typically involve excision of the retrocalcaneal bursa, resection of the calcaneal prominence, and debridement of the diseased Achilles tendon.This article aims to provide an evidence-based literature review for the surgical management of Haglund's deformity. A comprehensive evidence-based literature review of the PubMed database conducted in July 2021 identified 20 relevant articles assessing the efficacy of surgical modalities for Haglund's deformity. The 20 studies were assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against the surgical modality. Qualitative and quantitative analysis was performed for the 20 studies.The results show that both open and endoscopic surgical modalities are efficacious in the treatment of Haglund's deformity, significantly improving functional outcome scores such as American Orthopaedic Foot & Ankle Society (AOFAS) scores and patient satisfaction post-operatively. Endoscopic surgery appears to have the advantage of shorter operative times, lower complication rates, and better cosmesis. More studies are required to further validate and optimize these surgical techniques.

Endoscopic Calcaneoplasty With Bony Debridement and Radiofrequency

“…Good clinical outcomes after endoscopic calcaneoplasty have been previously described by various studies, 2 , 10 and these outcomes were also recently shown by Yuen et al. 6 to be comparable to outcomes after open surgery.…”

“… 2 , 3 Endoscopic surgery offers advantages of less operating time and reduced postoperative complications such as Achilles tendon avulsion, surgical wound issues, and postoperative stiffness and pain 4 , 5 while attaining equally good outcomes as open surgery. 6 Techniques for endoscopic calcaneoplasty have been described with variations in portals used and patient positioning. 7 , 8 , 9 …”

Haglund’s syndrome: a case description

“…Conservative treatments such as training modification (eccentric exercise), extra-corporeal shock wave therapy (ESWT), nonsteroidal anti-inflammatory medication (NSAIDs), and electrotherapy (microcurrent and microwave), are the first choices for patients with Haglund's syndrome (13)(14)(15)(16). Surgery is recommended when conservative treatment has been ineffective after at least 6 months (4,17,18).…”

Secondary Achilles Tendon Repair After Calcaneal Exostectomy for Haglund Deformity Using a Unique Surgical Technique

“…17 Overall complications range from 0% to 53%. In the Yuen et al's 18 systematic review, the overall complication rate was 12.3%. The most common complications reported in the literature were paresthesias and incisional numbness.…”