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Surgical Treatment of Haglund's Deformity: A Systematic Review and Meta-Analysis
Wen Loong Paul Yuen1, Pei Ting Tan2, Kam King Charles Kon1
1Department of Orthopaedic Surgery, Changi General Hospital, Singapore, SGP.
Insights
Surgical management for Haglund's deformity, a cause of heel pain, is effective. Both open and endoscopic surgeries improve patient outcomes, with endoscopic procedures offering faster recovery and fewer complications.
Area of Science:
- Orthopedic Surgery
- Podiatry
- Sports Medicine
Background:
- Haglund's deformity, or posterosuperior calcaneal prominence, frequently causes retrocalcaneal bursitis and posterior heel pain.
- Surgical intervention is considered for persistent symptoms unresponsive to conservative treatments like medication, physical therapy, and footwear adjustments.
Purpose of the Study:
- To conduct an evidence-based literature review on the surgical management of Haglund's deformity.
- To evaluate the efficacy and outcomes of different surgical techniques for Haglund's deformity.
Main Methods:
- A comprehensive literature search of the PubMed database was performed in July 2021.
- Twenty relevant studies were identified, assessed for level of evidence (I-IV), and graded for recommendation (A-C, I).
- Qualitative and quantitative analyses were conducted on the selected studies.
Main Results:
- Both open and endoscopic surgical approaches demonstrated efficacy in treating Haglund's deformity.
- Significant improvements were observed in functional outcome scores, such as the American Orthopaedic Foot & Ankle Society (AOFAS) scores, and patient satisfaction.
- Endoscopic surgery showed potential advantages including shorter operative times, reduced complication rates, and improved cosmetic results.
Conclusions:
- Open and endoscopic surgical options are effective for managing Haglund's deformity, leading to better functional outcomes and patient satisfaction.
- Endoscopic surgery may offer benefits regarding operative time, complications, and aesthetics.
- Further research is needed to optimize and validate these surgical techniques.
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.
