Haglund Excision and Suture Bridge Repair

Haglund deformity and insertional Achilles tendinopathy involve a degenerative process demonstrating disorganized collagen and mucoid degenerative material causing pain and swelling.

Operative management through a distally based midline incision should be explored if symptoms are refractory to nonoperative management (activity and shoewear modifications, heel lifts, physical therapy, and heel sleeves). Direct lateral approach with small longitudinal split and removal of lateral prominence "pump bump" is performed when a patient has pain isolated solely to the prominence. We feel that endoscopic removal does not allow for appropriate evaluative of degenerative tissue.

Through a distally based incision, we dissect to the level of the paratenon and make one smooth cut through paratenon and tendon. We then excise the mucoid, degenerative tissue. Removal of Haglund deformity and exostosis is carefully accomplished with a saw. We then utilize a rongeur to smooth Haglund deformity and any remaining medial/lateral calcaneal prominences. We then complete a dual-row speed bridge with 4 suture anchors (horizontal mattress) and a modified Mason-Allen technique. A Thompson test is then repeated and the longitudinal split is repaired. Postoperatively, we have patients weight bear as tolerated in a boot for with suture removal and transition to shoewear at the 2-week mark. We begin range of motion and activity once the wound has healed. We expect return to sport beginning at 3 months with full return by 6 months.

The current body of literature shows significant patient satisfaction and minimal risk of complication. Some authors have shown significant improvement in American Orthopaedic Foot and Ankle Score (AOFAS) scores, with only 1 patient requiring a flexor hallucis longus (FHL) transfer and no complications. Further studies identify early weight-bearing in Achilles suture bridge technique to have some promise with improvement in visual analog scale (VAS)/AOFAS scores, though there is risk of wound breakdown.

An Achilles suture bridge technique with early weight-bearing is a viable option for patients with Haglund deformity, and insertional Achilles tendinopathy who have failed conservative management.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.