Haglund Excision and Suture Bridge Repair.

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery

Background:

• Haglund deformity and insertional Achilles tendinopathy are characterized by disorganized collagen and mucoid degeneration, leading to pain and swelling.
• These conditions result from a degenerative process affecting the Achilles tendon and heel bone.

Purpose of the Study:

• To explore operative management for Haglund deformity and insertional Achilles tendinopathy refractory to nonoperative treatments.
• To evaluate the efficacy and outcomes of a distally based midline incision technique with an Achilles suture bridge repair.

Main Methods:

• A distally based midline incision is used to access and excise degenerative tissue and the Haglund deformity.
• An Achilles suture bridge technique with dual-row suture anchors and a modified Mason-Allen technique is employed for tendon repair.
• Postoperative management includes early weight-bearing as tolerated, transitioning to regular footwear at two weeks, and gradual return to activity.

Main Results:

• Literature review indicates significant patient satisfaction and a low risk of complications with surgical intervention.
• Studies report improvements in American Orthopaedic Foot and Ankle Score (AOFAS) scores, with minimal need for additional procedures like flexor hallucis longus (FHL) transfer.
• Early weight-bearing protocols show promise for improving visual analog scale (VAS) and AOFAS scores, although wound breakdown is a potential risk.

Conclusions:

• The Achilles suture bridge technique with early weight-bearing is a feasible surgical option for managing Haglund deformity and insertional Achilles tendinopathy.
• This approach is recommended for patients who have not responded to conservative management strategies.