Early Outcomes With Early Weightbearing Using Willits Protocol Following Haglund's Surgery

Insertional Achilles tendinopathy is a common condition treated by foot and ankle surgeons. The literature has demonstrated good outcomes following detachment and reattachment of the Achilles with partial calcanectomy. However, postoperative protocols are variable and have not been well established. The purpose of the present study was to retrospectively review early mobilization with the Willits protocol following insertional Achilles tendinopathy surgery.

A retrospective chart review was conducted of 25 patients (29 feet) who underwent surgical treatment for insertional Achilles tendinopathy with Haglund's deformity by two foot and ankle surgeons. Patients were evaluated using radiographs and clinical exams. Following surgery, Willits protocol was initiated for early mobilization.

Patients had an average decrease in pain postoperatively from 6.14 to 1.53 on a 10-point scale. One patient (3.4%) experienced a postoperative rupture after trauma. Three patients (10.3%) required reoperation: one debridement for postoperative infection, one flexor hallucis longus transfer and V-Y lengthening for Achilles rupture after a fall, and one gastrocnemius recession for calf tightness.

The Willits protocol, although initially created for Achilles tendon ruptures, provides an early mobilization protocol for patients after insertional Achilles tendinopathy procedures. Our study found a low reoperation rate and improved pain level while allowing patients to mobilize earlier than previously reported in the literature.