Surgery for Haglunds / Retrocalcaneal Bursitis

NewsBot · Jul 27, 2023

Surgical Treatment of Haglund's Disease: About 9 Cases
Abakka M et al
Source

Haglund's disease is a rare disease of the hindfoot, linked to a morphological anomaly of the calcaneus posterosuperior tuberosity, causing pre and retro-Achilles bursitis and insertional tendinopathy. The purpose of our work is to
analyze the functional results according to long-term resections of the posterosuperior tuberosity of the calcaneus,
specifying the radio-clinical and therapeutic aspects of this pathology. Our study is a retrospective study of nine cases
of Haglund's disease operated in the Department of Orthopedic and Traumatology at the Ibn Sina hospital in Rabat,
between 2019 and 2023, correlated with a simple literature review. The average age of our patients was 41 years old
with a male predominance. All our patients showed painful retrocalcaneal swelling. The diagnosis was confirmed by
radiological explorations (standard radiography and MRI). After failure of medical treatment, surgery consisted in an
open resection of the postero-superior tuberosity of the calcaneus. The evolution was favorable in 92% of cases.
Complications were rare. Haglund's disease is a pathology often underestimated, we must think about it before all
Achilles insertion tendinopathy. Resection of the tuberosity is a simple technique, with undeniable effectiveness, and
which is considered the best treatment.
Click to expand...

NewsBot · Nov 14, 2023

Platelet rich plasma (PRP) in the surgical treatment of Haglund's syndrome: the use of PRP membranes as an intra-operative local adjuvant
Giuseppe Restuccia et al\
Med Glas (Zenica). 2024 Feb 1;21(1)

Aim Haglund's syndrome may be responsible for chronic pain in the ankle and hindfoot. Although numerous therapeutic approaches have been described in the literature, to this date no consensus over a surgical treatment has been established. We report our experience in the treatment of Haglund's syndrome and pre-insertional calcifications of the Achilles tendon using an open surgical approach and platelet rich plasma (PRP) membranes as a local adjuvant. Methods The study retrospectively evaluated patients with Haglund syndrome treated with a direct posterior access, Achilles tendon split, bursectomy, resection of the heel deformity and topical administration of PRP membranes. After surgery, a standardized rehabilitation protocol was performed. The preoperative and postoperative functionalities of the foot and ankle were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score. Intraoperative and postoperative complications were recorded. Results Twenty consecutive patients were included. The mean follow-up was 23 months. No patient had major intraoperative or postoperative complications. After the surgery, the mean AOFAS score increased from 44.1 to 92.0, resulting in a statistically significant increase in patient functionality after the treatment (p=0.001). Conclusion Our results suggest that an open surgical approach consisting of a combination of bursectomy, resection of the calcaneal deformity, and topical administration of PRP membranes may be effective for the treatment of Haglund's disease.
Click to expand...

NewsBot · Nov 14, 2023

Effect of sequential burr passes on osteotomy magnitude and calcaneal morphology in minimally invasive Zadek osteotomy
Bedri Karaismailoglu et al
Foot Ankle Surg. 2023 Oct 30

Purpose: This study aimed to evaluate the impact of each burr pass on degree of correction, gap size and calcaneal morphology in MIS Zadek osteotomy.

Methods: MIS Zadek osteotomy was performed on ten cadaveric specimens using a 3.1 mm Shannon burr. After each burr pass, the osteotomy gap was manually closed, and the subsequent burr passes were carried out with the foot held in dorsiflexion, which was repeated five times. Lateral X-rays were taken before and after each burr pass. Two independent reviewers measured the dorsal calcaneal length after each burr passage, as well as changes in several calcaneal parameters including X/Y ratio, Fowler Philip angle, and Böhler angle.

Results: The average decrease in dorsal calcaneal cortical length with each burr pass was as follows: 2.6 ± 0.9 mm at the 1st pass, 2.4 ± 1 mm at the 2nd pass, 2 ± 1 mm at the 3rd pass, 1.6 ± 1 mm at the 4th pass, and 1.4 ± 0.7 mm at the 5th pass. The Fowler Philip and Böhler angles consistently decreased while the X/Y ratio consistently increased following each consecutive burr pass. Interobserver reliability analysis demonstrated good agreement for all parameters.

Conclusion: The results revealed the trends of length and anatomical changes in the calcaneus with each burr pass. On average, a dorsal wedge resection of 10 mm was achieved after 5 burr passes. This data can aid surgeons in determining the optimal number of burr passes required for a particular amount of resection, ensuring the attainment of the desired patient-specific surgical outcome.
Click to expand...

NewsBot · Jan 4, 2024

Landmarks for a Minimally Invasive Approach for Haglund's Deformity: A Cadaveric Study
Sara Mateen et al
Foot Ankle Spec. 2023 Nov 29

Introduction: Haglund's deformity is a posterosuperior calcaneal prominence often associated with a painful bursa and insertional Achilles tendinopathy. Endoscopic debridement has been previously described; however, the aim of this cadaveric study is to describe landmarks of a minimally invasive surgical (MIS) approach to Haglund's deformity.

Methods: Twelve specimens were dissected to identify medial and lateral portals for minimally invasive burr placement and anchor placement. A standard ruler was used to measure the distance in millimeters from the medial and lateral neurovascular structures in relation to medial and lateral portals. A separate 7-cm longitudinal incision posterior to the lateral malleolus and a separate 7-cm longitudinal incision posterior to the medial malleolus were made to identify at-risk neurovascular structures.

Results: The average distance from the sural nerve to the lateral portal was 25.7 mm (23-26). The mean distance from the lateral calcaneal branch of the sural nerve to lateral portal was 11.4 mm (10-12). The mean distance from the tibial nerve to the medial portal was 35.3 mm (35-36). Both the medial and lateral incisions were 9.3 mm from the calcaneal tuberosity.

Conclusion: The results indicate that the MIS approach to Haglund's deformity resection can be performed reliably without neurovascular compromise.
Click to expand...

NewsBot · Apr 17, 2024

Ankle Muscle Strength and Gait Function After Dorsal Closing Wedge Calcaneal Osteotomy for Haglund Exostosis–Related Heel Pain
Bernd Friesenbichler, et al
Source

Background:
Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists.
Methods:
Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed.
Results:
Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as “helped” or “helped a lot” (Global Treatment Outcome).
Conclusion:
In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up.
Click to expand...

NewsBot · Apr 17, 2024

Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund's Deformity: A Systematic Review
Yianni Bakaes et al
Foot Ankle Orthop. 2024 Apr 12;9(2)

Background: Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines.

Methods: A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies.

Results: A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO.

Conclusion: Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.
Click to expand...

NewsBot · Apr 22, 2024

Haglund resection versus Haglund non-resection for calcific insertional Achilles tendinopathy with Haglund deformity: A retrospective study
Lin Ma et al
Foot Ankle Surg. 2024 Mar 13

Background: Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity.

Methods: A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively.

Results: Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018).

Conclusion: Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformit
Click to expand...

NewsBot · Apr 30, 2024 at 7:06 AM

Minimally Invasive Approaches to Haglund’s Deformity and Insertional Achilles Tendinopathy: A Contemporary Review
SarahRose Hall et al
Source

Introduction
Minimally invasive surgical (MIS) procedures are becoming increasingly popular in foot and ankle surgery. Several benefits of MIS procedures have been reported in the literature including decreased postoperative pain, shorter recovery times, and lower need for postoperative narcotics.10,11,33,53,71,72 Specifically regarding Haglund deformity (HD) and insertional Achilles tendinopathy (IAT), MIS techniques have been increasingly used over the last decade.
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.
Click to expand...

Surgery for Haglunds / Retrocalcaneal Bursitis

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

haglunds surgery #2

Limb Length Discrepancy After Total Hip Joint Replacement Surgery Treated With Heel Lifts

Workers' Compensation After Foot and Ankle Surgery

Mental health and outcomes of foot and ankle surgery

Metal hypersensitivity in foot & ankle surgery

Ankle Edema Following Trauma or Surgery

Intellectual Property and Royalty Payments Among Foot and Ankle Surgery Fellowship Faculty

Share This Page

Surgery for Haglunds / Retrocalcaneal Bursitis

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

haglunds surgery #2

Limb Length Discrepancy After Total Hip Joint Replacement Surgery Treated With Heel Lifts

Workers' Compensation After Foot and Ankle Surgery

Mental health and outcomes of foot and ankle surgery

Metal hypersensitivity in foot & ankle surgery

Ankle Edema Following Trauma or Surgery

Intellectual Property and Royalty Payments Among Foot and Ankle Surgery Fellowship Faculty

Share This Page

Useful Searches