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Surgical Correction of Haglund's Triad Using a Central Tendon-Splitting Approach: A Retrospective Outcomes Study

Published:August 11, 2017DOI:https://doi.org/10.1053/j.jfas.2017.05.015

      Abstract

      We evaluated the surgical outcomes of Haglund's triad using a central tendon-splitting approach, with Achilles tendon partial detachment and debridement, excision of the retrocalcaneal bursa, resection of Haglund's prominence, and reattachment of the Achilles tendon. The medical records of 22 patients (22 heels) who had undergone surgical correction of Haglund's triad from January 2010 to December 2015 were reviewed retrospectively. The visual analog scale pain score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical and mental component scores were prospectively collected preoperatively, 6 months postoperatively, and at the last visit. The scores of a subjective question involving satisfaction were prospectively collected at the last visit. Possible risk factors were also evaluated. We reviewed the data from 12 females and 10 males, with the mean age of 59.2 ± 7.3 years and a mean follow-up duration of 15.1 ± 4.6 months. Significant improvement was found in the mean visual analog scale pain score, average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical component scale score. The overall satisfaction rate was 77.3% (17 of 22). Postoperative complications included 2 cases of delayed wound healing and 1 case of sensation loss over the heel wound. No Achilles tendon rupture or wound infection developed. Gender and body mass index did not affect the surgical outcomes. The surgical technique we used for Haglund's triad provided effective pain relief, function improvement, and overall enhancement of patients' health condition. More research is required to further evaluate the outcomes of our surgical approach to treat Haglund's triad and the possible risk factors.

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      References

        • DeVries J.
        • Summerhays B.
        • Guehlstorf D.
        Surgical correction of Haglund's triad using complete detachment and reattachment of the Achilles tendon.
        J Foot Ankle Surg. 2009; 48: 447-451
        • Haglund P.
        Bietrag zur klink der achillessehne.
        Orthop Chir. 1928; 49: 49-58
        • Tu P.
        • Bytomski J.
        Diagnosis of heel pain.
        Am Fam Physician. 2011; 84: 909-916
        • Thomas J.L.
        • Christensen J.C.
        • Kravitz S.R.
        • Mendicino R.W.
        • Schuberth J.M.
        • Vanore J.V.
        • Weil Sr., L.S.
        • Zlotoff H.J.
        • Bouché R.
        • Baker J.
        • American College of Foot and Ankle Surgeons Heel Pain Committee
        The diagnosis and treatment of heel pain: a clinical practice guideline—revision 2010.
        J Foot Ankle Surg. 2010; 49: S1-S19
        • Notari M.A.
        • Mittler B.E.
        An investigation of Fowler-Philip's angle in diagnosing Haglund's deformity.
        J Am Podiatry Assoc. 1984; 74: 486-489
        • Irwin T.
        Current concepts review: insertional Achilles tendinopathy.
        Foot Ankle Int. 2010; 31: 933-939
        • Kitaoka H.B.
        • Alexander I.J.
        • Adelaar R.S.
        • Nunley J.A.
        • Myerson M.S.
        • Sanders M.
        Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.
        Foot Ankle Int. 1994; 15: 349-353
        • Ware Jr., J.E.
        • Sherbourne C.D.
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Ware J.E.
        • Kosinski M.
        • Keller S.D.
        SF-36 Physical and Mental Health Summary Scales: A User's Manual.
        Health Institute, New England Medical Center, Boston1994
        • Ware Jr., J.E.
        • Kosinski M.
        • Bayliss M.S.
        • McHorney C.A.
        • Rogers W.H.
        • Raczek A.
        Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study.
        Med Care. 1995; 33: AS264-AS279
        • Lin H.A.
        • Chong H.A.
        • Yeo W.
        Calcaneoplasty and reattachment of the Achilles tendon for insertional tendinopathy.
        J Orthop Surg (Hong Kong). 2014; 22: 56-59
        • McGarvey W.
        • Palumbo R.
        • Baxter D.
        • Leibman B.D.
        Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach.
        Foot Ankle Int. 2002; 23: 19-25
        • WHO Expert Consultation
        Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363: 157-163
        • Gan G.L.
        • Pang J.
        Obesity in Singapore, prevention and control.
        Singapore Fam Physician. 2012; 38: 8-13
        • Ettinger S.
        • Razzaq R.
        • Waizy H.
        • Claassen L.
        • Daniilidis K.
        • Stukenborg-Colsman C.
        • Plaass C.
        Operative treatment of the insertional Achilles tendinopathy through a transtendinous approach.
        Foot Ankle Int. 2016; 37: 288-293
        • Miao X.D.
        • Jiang H.
        • Wu Y.P.
        • Tao H.M.
        • Yang D.S.
        • Hu H.
        Treatment of calcified insertional Achilles tendinopathy by the posterior midline approach.
        J Foot Ankle Surg. 2016; 55: 529-534
        • Ahn J.H.
        • Ahn C.Y.
        • Byun C.H.
        • Kim Y.C.
        Operative treatment of Haglund syndrome with central Achilles tendon-splitting approach.
        J Foot Ankle Surg. 2015; 54: 1053-1056
        • Anderson J.
        • Suero E.
        • O'Loughlin P.
        • Kennedy J.
        Surgery for retrocalcaneal bursitis: a tendon-splitting versus a lateral approach.
        Clin Orthop Relat Res. 2008; 466: 1678-1682
        • Traina F.
        • Perna F.
        • Ruffilli A.
        • Mazzotti A.
        • Meliconi R.
        • Berti L.
        • Faldini C.
        Surgical treatment of insertional Achilles tendinopathy: a systematic review.
        J Biol Regul Homeost Agents. 2016; 30: 131-138
        • Wiegerinck J.I.
        • Kerkhoffs G.M.
        • van Sterkenburg M.N.
        • Sierevelt I.N.
        • van Dijk C.N.
        Treatment for insertional Achilles tendinopathy: a systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 1345-1355
        • Kondreddi V.
        • Gopal R.K.
        • Yalamanchili R.K.
        Outcome of endoscopic decompression of retrocalcaneal bursitis.
        Indian J Orthop. 2012; 46: 659-663
        • Witt B.
        • Hyer C.
        Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series.
        J Foot Ankle Surg. 2012; 51: 487-493
        • Nunley J.
        • Ruskin G.
        • Horst F.
        Long-term clinical outcomes following the central incision technique for insertional Achilles tendinopathy.
        Foot Ankle Int. 2011; 32: 850-855
        • Attinger C.
        • Evans K.
        • Bulan E.
        • Blume P.
        • Cooper P.
        Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization.
        Plast Reconstr Surg. 2006; 117: 261S-293S
        • Oliva F.
        • Via A.G.
        • Maffulli N.
        Physiopathology of intratendinous calcific deposition.
        BMC Med. 2012; 10: 95
        • Gillis C.T.
        • Lin J.S.
        Use of a central splitting approach and near complete detachment for insertional calcific Achilles tendinopathy repaired with an Achilles bridging suture.
        J Foot Ankle Surg. 2016; 55: 235-239
        • Johnson K.
        • Zalavras C.
        • Thordarson D.
        Surgical management of insertional calcific Achilles tendinosis with a central tendon splitting approach.
        Foot Ankle Int. 2006; 27: 245-250
        • Fridrich F.
        [Tendon-splitting approach for the surgical treatment of Haglund's deformity and associated condition: evaluation and results].
        Acta Chir Orthop Traumatol Czech. 2009; 76: 212-217
        • Highlander P.
        • Greenhagen R.
        Wound complications with posterior midline and posterior medial leg incisions: a systematic review.
        Foot Ankle Spec. 2011; 4: 361-369
        • McAlister J.E.
        • Hyer C.F.
        Safety of Achilles detachment and reattachment using a standard midline approach to insertional enthesophytes.
        J Foot Ankle Surg. 2015; 54: 214-219
        • Kolodziej P.
        • Glisson R.
        • Nunley J.
        Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund's deformity: a biomechanical study.
        Foot Ankle Int. 1999; 20: 433-437
        • Calder J.
        • Saxby T.
        Surgical treatment of insertional Achilles tendinosis.
        Foot Ankle Int. 2003; 24: 119-121
        • Wagner E.
        • Gould J.
        • Bilen E.
        • Fleisig G.S.
        • Wilk K.
        • Fowler R.
        Change in plantarflexion strength after complete detachment and reconstruction of the Achilles tendon.
        Foot Ankle Int. 2004; 25: 800-804
        • Maffulli N.
        • Testa V.
        • Capasso G.
        • Sullo A.
        Calcific insertional Achilles tendinopathy: reattachment with bone anchors.
        Am J Sports Med. 2004; 32: 174-182
        • Wagner E.
        • Gould J.
        • Kneidel M.
        • Fleisig G.S.
        • Fowler R.
        Technique and results of Achilles tendon detachment and reconstruction for insertional Achilles tendinosis.
        Foot Ankle Int. 2006; 27: 677-684
        • Schneider W.
        • Niehus W.
        • Knahr K.
        Haglund's syndrome: disappointing results following surgery—a clinical and radiographic analysis.
        Foot Ankle Int. 2000; 21: 26-30
        • Brunner J.
        • Anderson J.
        • O'Malley M.
        • Bohne W.
        • Deland J.
        • Kennedy J.
        Physician and patient based outcomes following surgical resection of Haglund's deformity.
        Acta Orthop Belg. 2005; 71: 718-723