Related Experiment Videos
Haglund's syndrome
E J Sella1, D S Caminear, E A McLarney
1Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT, USA.
Insights
This study introduces a radiographic method to accurately measure bone removal during calcaneal osteotomy for Haglund's syndrome, improving surgical outcomes for heel pain.
Area of Science:
- Orthopedic Surgery
- Radiology
- Biomechanical Engineering
Background:
- Haglund's syndrome causes heel pain due to inflammation from mechanical stress.
- Surgical calcaneal osteotomy for Haglund's syndrome has unpredictable outcomes due to inaccurate bone removal measurement.
- Accurate assessment of bone removal is crucial for effective surgical management of Haglund's syndrome.
Purpose of the Study:
- To develop and validate a radiographic method for precise measurement of bone removal during calcaneal osteotomy.
- To correlate osteotomy angle with surgical outcomes in Haglund's syndrome patients.
- To establish an optimal osteotomy angle for successful surgical treatment of Haglund's syndrome.
Main Methods:
- A radiographic technique was developed to measure bone removal during calcaneal osteotomy.
- Sixteen heels in 13 patients with Haglund's syndrome underwent surgery after failed conservative treatment.
- Preoperative desired osteotomy angles were compared to actual surgical angles; patient outcomes were assessed using a standardized questionnaire.
Main Results:
- A statistically significant correlation was found between osteotomy angle and patient outcomes (p = .0012).
- Good surgical results (13 patients) were associated with an average actual osteotomy angle of 49 degrees.
- Poor surgical results (3 patients) were associated with an average actual osteotomy angle of 61 degrees, with lower patient-reported scores.
Conclusions:
- The developed radiographic method allows for accurate measurement of bone removal in calcaneal osteotomy for Haglund's syndrome.
- Achieving an average osteotomy angle of 49 degrees is recommended for optimal surgical outcomes.
- This technique aids in decompressing the retrocalcaneal bursa and removing the calcaneal step, addressing the mechanical causes of Haglund's syndrome.
Abstract:
Haglund's syndrome is a painful condition of the heel caused by mechanically induced inflammation of the retrocalcaneal bursa, supracalcaneal bursa, and Achilles tendon. Surgical management has included calcaneal osteotomy, but results have been unpredictable because of the inability to measure accurately bone removal. A method was devised in this study to accurately determine radiographically the amount of bone removal necessary. Sixteen heels in 13 patients underwent surgery after failing 21 months of conservative treatment. The desired osteotomy angle (preop x-rays) was compared to the actual angle obtained at surgery. A patient questionnaire, developed by the Outcome Study Committee of the AOFAS, was used to assess results. There were 13 good results and 3 failures. The average actual angle of the good results was 49 degrees and that of the poor results was 61 degrees. These results were statistically significant to a p = .0012. The average score obtained by the good results was 87 points, while that of the failures was 25 points. Follow-up was 42 months. The authors recommend that the osteotomy be made in such a way as to remove not only the superolateral deformity, but also to decompress the retrocalcaneal bursa and to remove the calcaneal step. In order to do so, an osteotomy angle of 49 degrees should be achieved.