Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 6 , ISSUE 1 ( January-June, 2019 ) > List of Articles

Original Article

Surgical Treatment of Insertional Achilles Tendinosis and Haglunds Deformity by Using Central Tendon-splitting Approach: Retrospective Case Series of 15 Cases

Malhar Dave, Heloni M Dave, Rakesh Rathava, Niravkumar P Moradiya

Keywords : Achilles tendinosis, Chronic achilles tendinopathy, Haglund\'s deformity

Citation Information : Dave M, Dave HM, Rathava R, Moradiya NP. Surgical Treatment of Insertional Achilles Tendinosis and Haglunds Deformity by Using Central Tendon-splitting Approach: Retrospective Case Series of 15 Cases. J Foot Ankle Surg Asia-Pacific 2019; 6 (1):18-22.

DOI: 10.5005/jp-journals-10040-1099

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Purpose of the study: Haglund\'s deformity or pump bump is a degenerative process and is a common cause of posterior heel pain. Operative treatment is required when conservative treatment fails and the symptoms are not relieved. Different surgical procedures and approaches have been used for this deformity. But in the literature, the results have been inconsistent. In this study, we retrospectively evaluated the clinical and functional outcome of operative treatment with debridement of the retrocalcaneal bursa and the Achilles tendon using a central tendon-splitting approach. Materials and methods: A total of 15 patients that underwent a surgical procedure were included in this study. The study duration was from January 2006 to June 2011. The clinical and functional outcome was evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) score. All patients were operated in the prone position by using a central tendon-splitting approach. Results: The mean follow-up period was 26 months. The mean AOFAS ankle–hind foot score had improved by 33 points from the preoperative mean score (37), with a mean score of 70 at the final follow-up. No complications (wound dehiscence and tendon avulsion) were noted. Out of 15 patients, all patients had good results except one due to persistent pain. Conclusion: We concluded that the central approach to surgical correction is an effective method with a good clinical and functional outcome in patients with refractory Haglund\'s deformity.


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  1. Anderson JA, Suero E, et al. Surgery for retrocalcaneal bursitis: a tendon-splitting versus a lateral approach. Clin Orthop Relat Res 2008;466:1678–1682. DOI: 10.1007/s11999-008-0281-9.
  2. Chen CH, Huang PJ, et al. Surgical treatment for Haglund's deformity. Kaohsiung J Med Sci 2001 Aug;17(8):419–422.
  3. Fridrich F. Tendon-splitting approach for the surgical treatment of Haglund's deformity and associated condition. Evaluation and results. Acta Chir Orthop Traumatol Cech 2009;76(3):212–217.
  4. Rodrigues RC, Masiero D, et al. Translation, cultural adaptation and validity of the american orthopaedic foot and ankle society (AOFAS) ankle-hindfoot scale. Acta Ortop Bras. [serial on the Internet] 2008;16(2):107–111. DOI: 10.1590/S1413-78522008000200009.
  5. James AN, Glenn BP, et al. Advanced Reconstruction, foot and ankle. American Academy of Orthopaedic Surgeons (AAOS), 2004.
  6. Kolodziej P, Glisson RR, et al. Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund's deformity: a biomechanical study. Foot Ankle Int 1999;20(7):433–437. DOI: 10.1177/107110079902000707.
  7. Myerson MS, McGarvey W. Disorders of the Achilles tendon insertion and Achilles tendinitis. Instr Course Lect 1999;48:211–218.
  8. Watson AD, Anderson RB, et al. Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional Achilles tendinosis with calcific spur. Foot Ankle Int 2000;21(8):638–642. DOI: 10.1177/107110070002100802.
  9. David BT. Foot and Ankle (Orthopaedic Surgery Essentials), 2nd ed. 2012.
  10. Wagner E, Gould JS, et al. Technique and Results of Achilles Tendon Detachment and Reconstruction for Insertional Achilles Tendinosis. Foot Ankle Int 2006;27(9):677–684. DOI: 10.1177/107110070602700904.
  11. Astrom M, Rausing A. Chronic Achilles Tendinopathy. A Survey of Surgical and Histopathologic Findings. Clin Orthop Relat Res 1995;316:151–164. DOI: 10.1097/00003086-199507000-00021.
  12. Pavlov H, Heneghan MA, et al. The Haglund syndrome: initial and differential diagnosis. Radiology 1982;144(1):83–88. DOI: 10.1148/radiology.144.1.7089270.
  13. Lawrence DA, Rolen MF, et al. MRI of heel pain. Am J Roentgenol 2013;200(4):845–855. DOI: 10.2214/AJR.12.8824.
  14. Kleinman M, Gross AE. Achilles tendon rupture following steroid injection. Report of three cases. J Bone Surg Am 1983;65(9):1345–1347. DOI: 10.2106/00004623-198365090-00019.
  15. Wagner E, Gould JS, et al. Technique and Results of Achilles Tendon Detachment and Reconstruction for Insertional Achilles Tendinosis. Foot Ankle Int 2006;27(9):677–684. DOI: 10.1177/107110070602700904.
  16. Chiari Vulpiani M, Guzzini M, et al. Operative Treatment of Chronic Achilles Tendinopathy. Int Orthop 2003;27:307–310. DOI: 10.1007/s00264-003-0472-7.
  17. Yodlowski ML, Scheller Jr AD, et al. Surgical Treatment of Achilles Tendonitis by Decompression of the Retrocalcaneal Bursa and the Superior Calcaneal Tuberosity. Am J Sports Med 2002;30(3):318–321. DOI: 10.1177/03635465020300030301.
  18. Carmont MR, Maffulli N. Management of Insertional Achilles Tendinopathy Through a Cincinnati incision. BMC Musculoskelet Disord 2007;8:82. DOI: 10.1186/1471-2474-8-82.
  19. Johnson KW, Zalavras C, et al. Surgical Management of Insertional Calcific Achilles Tendinosis with a Central Tendon Splitting Approach. Foot Ankle Int 2006;27(4):245–250. DOI: 10.1177/107110070602700404.
  20. Calder JD, Saxby TS. Surgical Treatment of Insertional Achilles Tendinosis. Foot Ankle Int 2003;24(2):119–121. DOI: 10.1177/107110070302400203.
  21. McGarvey WC, Palumbo RC, et al. Insertional Achilles Tendinosis: Surgical Treatment Through a Central Tendon Splitting Approach. Foot Ankle Int 2002;23(1):19–25. DOI: 10.1177/107110070202300104.
  22. Kitaoka HB, Alexander IJ, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15(7):349–353. DOI: 10.1177/107110079401500701.
  23. Lu CC, Cheng YM, et al. Angle analysis of Haglund syndrome and its relationship with osseous variations and Achilles tendon calcification. Foot Ankle Int 2007;28(2):181–185. DOI: 10.3113/FAI.2007.0181.
  24. Sammarco GJ, Taylor AL. Operative management of Haglund deformity in the non athlete: a retrospective study. Foot Ankle Int 1998;19:724–729. DOI: 10.1177/107110079801901102.
  25. Sella EJ, Caminear DS, et al. Haglund syndrome. J Foot Ankle Surg 1998;37:110–114. DOI: 10.1016/S1067-2516(98)80089-6.
  26. Schneider W, Niehus W, et al. Haglund syndrome: disappointing results following surgery: a clinical and radiographic analysis. Foot Ankle Int 2000;21:26–30. DOI: 10.1177/107110070002100105.
  27. Natarajan S, Narayanan VL. Haglund deformity-Surgical resection by the lateral approach. Malaysian Orthop J 2015;9(1):1–3. DOI: 10.5704/MOJ.1503.006.
  28. Anderson JA, Suero E, et al. Surgery for Retrocalcaneal Bursitis: A Tendon-splitting versus a Lateral Approach. Clin Orthop Relat Res 2008;466(7):1678–1682. DOI: 10.1007/s11999-008-0281-9.
  29. McGarvey WC, Palumbo RC, et al. Insertional Achilles tendinosis: surgical treatment through a central splitting approach. Foot Ankle Int 2002;23(1):19–25. DOI: 10.1177/107110070202300104.
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