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Operative management of Haglund's deformity in the nonathlete: a retrospective study
1University of Cincinnati Medical Center, Ohio, USA.
Insights
Surgical treatment for Haglund's deformity offers good results for patients unresponsive to nonoperative care. This technique involves calcaneal tuberosity excision and Achilles tendon reattachment, yielding high patient satisfaction.
Area of Science:
- Orthopedic Surgery
- Podiatry
- Musculoskeletal Conditions
Background:
- Haglund's deformity, also known as "pump bump," commonly causes posterior heel pain.
- Nonoperative therapy is the usual initial management approach for this condition.
Purpose of the Study:
- To evaluate the surgical outcomes for patients with Haglund's deformity who failed nonoperative treatment.
- To assess the effectiveness of surgical excision of the posterior calcaneal tuberosity.
Main Methods:
- Retrospective review of 65 cases (53 patients) with symptomatic Haglund's deformity.
- Surgical technique included excision of the posterior calcaneal tuberosity, debridement, and Achilles tendon reattachment with bone anchors.
- Postoperative immobilization for 4 weeks.
Main Results:
- 65% of patients failed nonoperative therapy, proceeding to surgery.
- At an average follow-up of 155 weeks, 50% excellent and 47% good results were reported.
- Maryland Foot Score improved from 67/100 preoperatively to 92/100 postoperatively for operated heels.
Conclusions:
- Surgical treatment for Haglund's deformity yields predictably good results in patients who do not respond to nonoperative management.
- The described surgical technique demonstrates efficacy in alleviating posterior heel pain associated with Haglund's deformity.
Abstract:
Haglund's deformity, or "pump bump," is a common cause of posterior heel pain. Management of the condition usually consists of nonoperative therapy. This study presents a retrospective study of 65 cases (53 patients), with symptomatic Haglund's deformity in nonathletes (13 male and 40 female), who presented during a 4-year period (1989-1994). Sixty-five percent (39 heels) of these patients failed to respond to nonoperative therapy for an average of 62 weeks, (range, 4-260 weeks). This group of patients went on to operative treatment. Surgical management consisted of excision of the posterior calcaneal tuberosity through a medial longitudinal incision with debridement, reattachment of the Achilles tendon using bone anchors, and 4 weeks of postoperative immobilization. Thirty-nine patients (74%) were contacted for follow-up. The average follow-up period for these patients was 155 weeks, (range, 92-335 weeks). There were 50% excellent results, 47% good results, 3% fair results (1 patient), and no poor results. The Maryland Foot Score for operated heels was an average of 67/100 preoperative and an average of 92/100 postoperative. On unoperated heels the score was an average of 81/100 at first evaluation and an average of 86/100 at final evaluation. Complications included one recurrence of painful prominence, one wound infection, and one incisional neuroma. The outcome of these cases demonstrated that in those patients who fail nonoperative treatment, surgical treatment of Haglund's deformity produces a predictably good surgical result when performed using the technique described.