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Operative Treatment of Haglund Syndrome With Central Achilles Tendon-Splitting Approach
Jae Hoon Ahn1, Chi-Young Ahn2, Chu-Hwan Byun2
1Professor, Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Insights
Operative treatment using a central tendon-splitting approach effectively resolves chronic posterior heel pain in Haglund syndrome patients. This surgical method demonstrated significant improvements in clinical scores and patient satisfaction, offering a safe solution for intractable cases.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
- Podiatric Medicine
Background:
- Haglund syndrome causes chronic posterior heel pain due to a calcaneal prominence.
- Conservative treatments are often insufficient for severe cases.
- Surgical intervention is considered for intractable Haglund syndrome.
Purpose of the Study:
- To evaluate the clinical and radiologic outcomes of surgical treatment for Haglund syndrome.
- To assess the efficacy of the central tendon-splitting approach in managing posterior heel pain.
- To determine patient satisfaction following operative intervention.
Main Methods:
- Retrospective analysis of 15 patients (14 male, 1 female) with Haglund syndrome.
- Surgical treatment utilizing a central tendon-splitting approach.
- Assessment of clinical outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and Victorian Institute of Sport Assessment-Achilles (VISA-A) score.
- Radiographic evaluation of foot alignment, including lateral talo-first metatarsal angle, calcaneal pitch angle, Fowler-Philip angle, and parallel pitch line.
Main Results:
- Significant improvement in AOFAS scores (62.1 to 92.5) and VISA-A scores (53.2 to 89.6).
- All patients reported satisfaction with the surgical outcomes.
- Radiographic analysis confirmed cavus feet with altered angular measurements post-surgery, indicating correction of the deformity.
Conclusions:
- The central tendon-splitting approach is a safe and effective surgical option for treating Haglund syndrome.
- Operative treatment leads to substantial improvements in function and patient-reported outcomes.
- This surgical technique provides satisfactory results for patients with intractable posterior heel pain due to Haglund syndrome.
Abstract:
Haglund syndrome is characterized by chronic posterior heel pain associated with a posterosuperior calcaneal prominence. We assessed the clinical and radiologic outcomes after operative treatment of Haglund syndrome using the central tendon-splitting approach. Fifteen feet in 15 patients were investigated retrospectively after surgery. Of the 15 patients, 14 were males (93.3%) and 1 was female (6.7%). Their mean age was 33.1 ± 8.2 (range 20 to 50) years. The mean follow-up duration was 3.5 ± 1.5 years (range 24 to 90 months). The American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale and Victorian Institute of Sport Assessment-Achilles scores were investigated to assess the clinical outcomes. Patient satisfaction was assessed at the latest follow-up visit. The lateral talo-first metatarsal angle, calcaneal pitch angle, Fowler-Philip angle, and parallel pitch line were measured to assess the foot shape and radiographic outcomes. Clinically, the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score increased from 62.1 ± 7.5 preoperatively to 92.5 ± 3.5 at the latest follow-up visit. The mean Victorian Institute of Sport Assessment-Achilles score increased from 53.2 ± 7.4 to 89.6 ± 3.4. All patients were satisfied with the operative results. Radiographically, all patients had cavus feet with an increased lateral talo-first metatarsal angle (mean +5.9° ± 5.0°) and calcaneal pitch angle (mean 26.0° ± 3.8°). The mean Fowler-Philip angle decreased from 58.9° ± 15.0° to 32.5° ± 7.2° postoperatively, and the positive parallel pitch line had changed to a negative value in all cases. Operative treatment with the central tendon-splitting approach appears to be safe and satisfactory for intractable Haglund syndrome.
