The Keck and Kelly Wedge Calcaneal Osteotomy for Haglund's Deformity: A Technique for Reproducible Results

Boffeli, Troy J.; Peterson, Matt A.

doi:10.1053/j.jfas.2012.03.002

Cited by 40 publications

(31 citation statements)

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“…Comparing our work with the literature, we noticed that few studies took into account the very common comorbidities in this type of problem, and did not apply the Silfverskiöld test, which assesses the shortening of the gastrocnemius/soleus complex, a frequent finding in patients with insertional tendinopathy (95% of our cases). Our preoperative assessment had a much lower AOFAS score than the mean score found in the literature studied (50.1 versus 56.4), which partly explains why our final score was below the mean recorded in the literature (83.75 versus 90.0), as our patients were potentially more severe cases who had been disabled for longer (5)(6)(7)(8)(9)(10)(11) .…”

Section: Discussioncontrasting

confidence: 76%

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Insertional Achilles tendinopathy

2020

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Objective: Retrospectively analyze surgical procedures performed on patients with insertional Achilles (calcaneal tendon) tendinopathy, focusing on outcomes and the impact on the patients’ functional quality. Methods: A descriptive, retrospective, case series study drawn up by collecting data directly from the patients’ medical records. For the functional analysis of patients, we used the questionnaire of the adapted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). An assessment was carried out on each of the patients who underwent surgery at our hospital from 2010 to 2019, using the surgical technique described in this article, i.e., resection of the affected portion of the tendon with its subsequent reinsertion. Results: All surgical patients achieved an improvement in their AOFAS score and in pain levels, with good functional performance only three months into the postoperative period, from 50.1 to 83.75 (p<0.001). Conclusion: The use of the technique proved very effective, particularly in terms of the maintenance of foot function and important improvement in pain levels, thus producing a relevant increase in function among patients. Level of Evidence IV; Therapeutic Study; Case Series.

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Section: Discussioncontrasting

confidence: 76%

“…Another factor that contributed to our lower improvement score is that we assessed our patients at 3 months postoperatively, while all the others (5)(6)(7)(8)(9)(10)(11) were assessed at 24.4 months on average. Nonetheless, the improvement achieved with surgical treatment was significant from 50.1 to 83.75 (p<0.001).…”

Section: Discussionmentioning

confidence: 99%

Insertional Achilles tendinopathy

2020

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“…Boffeli set the anterior osteotomy at 90° to the weightbearing surface at the plantar apex and made the posterior cut from the calcaneal tubercles to the point posterior to the weightbearing aspect of the plantar calcaneal tubercle [23]. This approach had a slight impact on the insertion of the plantar fascia and the anatomic shape of plantar tubercles.…”

Section: Discussionmentioning

confidence: 99%

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

Hong

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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“…Different osteotomy methods and tips for the DCWCO have been reported previously. Boffeli set the anterior osteotomy at 90° to the weight-bearing surface at the plantar apex; while the posterior cut was made from the calcaneal tubercles to the point posterior to the weight-bearing aspect of the plantar calcaneal tubercle [21]. It had a slight impact on the insertion of the plantar fascia and the anatomic shape of plantar tubercles.…”

Section: Discussionmentioning

confidence: 99%

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

Hong

et al. 2020

Preprint

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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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The Keck and Kelly Wedge Calcaneal Osteotomy for Haglund's Deformity: A Technique for Reproducible Results

Cited by 40 publications

References 2 publications

Insertional Achilles tendinopathy

Insertional Achilles tendinopathy

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

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