ENDOSCOPIC CALCANEOPLASTY FOR Haglund’s DEFORMITY WITH HINDFOOT PAIN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 QIJie , GONGLiqun , LIUJun , LIYong , LIQuanyi

Department of Orthopaedics, Shaanxi Provincial People’s Hospital, Xi’an Shaanxi, 710068, P.R.China;

Corresponding author：

QIJie, Email: qj_dentist@163.com

Keywords：

Haglund’s deformity; Hindfoot pain; Endoscopy; Calcaneoplasty

DOI：

10.7507/1002-1892.20160142

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Objective To analyze the effectiveness of endoscopic calcaneoplasty (ECP) for treating hindfoot pain in patients with Haglund’s deformity by comparing with conservative treatment. Methods According to the included standard, 64 hindfoot pain patients (77 feet) with Haglund’s deformity treated between January 2007 and October 2013 were enrolled. Based on the patient’s sports habit, 39 patients (49 feet) who had no requirement on sports were given conservative treatment (control group) and 25 patients (28 feet) who had stable sports habit were given ECP (ECP group). There was no significant difference in age, gender, disease duration, disease side, Fowler-Philip angle, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score between 2 groups (P > 0.05). Results The patients were followed up 16-44 months (mean, 33.7 months) in ECP group, and 12-40 months (mean, 37.5 months) in control group. In control group, the syndrome in 34 cases (43 feet) disappeared after 2 weeks; pain was improved in 5 cases (6 feet), and pain disappeared at 3 weeks after orthesis immobilization; hindfoot pain recurred in 24 cases (30 feet) during following-up, 11 cases (13 feet) underwent ECP after 1 year. In ECP group, all incisions healed by first intention without nerve injury; no edema or pain was observed during follow-up. AOFAS ankle-hindfoot score was significantly improved in 2 groups when compared with score at pre-treatment (P < 0.05). With time, AOFAS ankle-hindfoot score gradually decreased in control group, but it gradually increased in ECP group. The AOFAS ankle-hindfoot score of ECP group was significantly higher than that of control group after treatment (P < 0.05). According to Ogilvie-Harris score system at 12 months, the results were excellent in 9 cases, good in 12 cases, and poor in 4 cases, with the excellent and good rate of 84.00% in ECP group; and the results were excellent in 8 cases, good in 14 cases, and poor in 17 cases, with the excellent and good rate of 56.41% in control group. There was significant difference in the excellent and good rate between 2 groups (Z=-2.194, P=0.028). Conclusion Under the premise of strict control of surgical indications, the ECP can bring satisfactory effectiveness for treatment of hindfoot pain in patients with Haglund’s deformity.

Citation： QIJie, GONGLiqun, LIUJun, LIYong, LIQuanyi. ENDOSCOPIC CALCANEOPLASTY FOR Haglund’s DEFORMITY WITH HINDFOOT PAIN. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(6): 700-704. doi: 10.7507/1002-1892.20160142 Copy

1.	Weiss E. Calcaneal spurs: examining etiology using prehistoric skeletal remains to understand present day heel pain. Foot(Edinb), 2012, 22(3): 125-129.
2.	Lohrer H, Arentz S. Impingement lesion of the distal anterior Achilles tendon in sub-Achilles bursitis and Haglund-pseudoexostosis—a therapeutic challenge. Sportverletz Sportschaden, 2003, 17(4): 181-188.
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12.	Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int, 2012, 33(6): 487-491.
13.	Lu CC, Cheng YM, Fu YC, 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.
14.	Singh R, Rohilla R, Siwach RC, et al. Diagnostic significance of radiologic measurements in posterior heel pain. The Foot, 2008, 18(2): 91-98.
15.	Morag G, Maman E, Arbel R. Endoscopic treatment of hindfoot pathology. Arthroscopy, 2003, 19(2): E13.
16.	Annette F. Haglund’s Deformity: AKA the Pump Bump or Bauer Bump. Podiatry Management, 2011, 30(8): 79-83.
17.	Schneider W, Niehus W, Knahr K. Haglundd’s syndrome: disappointing results following surgery—a clinical and radiographic analysis. Foot Ankle Int, 2000, 21(1): 26-30.
18.	Hamel J. Calcaneal Z osteotomy for correction of subtalar hindfoot varus deformity. Oper Orthop Traumatol, 2015, 27(4): 308-316.
19.	Brunner J, Anderson J, O’Malley M, et al. Physician and patient based outcomes following surgical resection of Haglund’s deformity. Acta Orthop Belg, 2005, 71(6): 718-723.
20.	Boffeli TJ, Peterson MC. The Keck and Kelly wedge calcaneal osteotomy for Haglund’s deformity: a technique for reproducible results. J Foot Ankle Surg, 2012, 51(3): 398-401.
21.	DeVries JG, Summerhays B, Guehlstorf DW. Surgical correction of Haglund’s triad using complete detachment and reattachment of the Achilles tendon. J Foot Ankle Surg, 2009, 48(4): 447-451.
22.	Ahn JH, Ahn CY, Byun CH, et al. Operative treatment of Haglund syndrome with central Achilles tendon-splitting approach. J Foot Ankle Surg, 2015, 54(6): 1053-1056.
23.	Frey C. Surgical advancements: arthroscopic alternatives to open procedures: great toe, subtalar joint, Haglund’s deformity, and tendoscopy. Foot Ankle Clin, 2009, 14(2): 313-339.
24.	Schunck J, Jerosch J. Operative treatment of Haglund’s syndrome. Basics, indications, procedures, surgical techniques, results and problems. Foot and Ankle Surgery, 2005, 11(3): 123-130.
25.	Jerosch J. Endoscopic calcaneoplasty. Foot Ankle Clin, 2015, 20(1): 149-165.

1. Weiss E. Calcaneal spurs: examining etiology using prehistoric skeletal remains to understand present day heel pain. Foot(Edinb), 2012, 22(3): 125-129.
2. Lohrer H, Arentz S. Impingement lesion of the distal anterior Achilles tendon in sub-Achilles bursitis and Haglund-pseudoexostosis—a therapeutic challenge. Sportverletz Sportschaden, 2003, 17(4): 181-188.
3. van Dijk CN. Hindfoot endoscopy for posterior ankle pain. Instr Course Lect, 2006, 55: 545-554.
4. Lohrer H, Nauck T, Dorn NV, et al. Comparison of endoscopic and open resection for Haglund tuberosity in a cadaver study. Foot Ankle Int, 2006, 27(6): 445-450.
5. Coull R, Raffiq T, James LE, et al. Open treatment of anterior impingement of the ankle. J Bone Joint Surg (Br), 2003, 85(4): 550-553.
6. Lee JC, Calder JD, Healy JC. Posterior impingement syndromes of the ankle. Semin Musculoskelet Radiol, 2008, 12(2):154-169.
7. Fowler A, Phillip JF. Abnormality of the calcaneus as a cause of painful heel: its diagnosis and operative treatment. Br J Surg, 1945, 32(128): 494-498.
8. Hung EHY, Kwok WK, Tong MMP. Haglund Syndrome—a Characteristic Cause of Posterior Heel Pain. J HK Coll Radiol, 2009, 11: 183-185.
9. Bulstra GH, van Rheenen TA, Scholtes VA. Can We Measure the Heel Bump? Radiographic Evaluation of Haglund’s Deformity. J Foot Ankle Surg, 2015, 54(3): 338-340.
10. Kucuksen S, Karahan AY, Erol K. Haglund syndrome with pump bump. Med Arch, 2012, 66(6): 425-427.
11. Sella EJ, Caminear DS, McLarney EA. Haglund’s syndrome. J Foot Ankle Surg, 1998, 37(2): 110-114.
12. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int, 2012, 33(6): 487-491.
13. Lu CC, Cheng YM, Fu YC, 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.
14. Singh R, Rohilla R, Siwach RC, et al. Diagnostic significance of radiologic measurements in posterior heel pain. The Foot, 2008, 18(2): 91-98.
15. Morag G, Maman E, Arbel R. Endoscopic treatment of hindfoot pathology. Arthroscopy, 2003, 19(2): E13.
16. Annette F. Haglund’s Deformity: AKA the Pump Bump or Bauer Bump. Podiatry Management, 2011, 30(8): 79-83.
17. Schneider W, Niehus W, Knahr K. Haglundd’s syndrome: disappointing results following surgery—a clinical and radiographic analysis. Foot Ankle Int, 2000, 21(1): 26-30.
18. Hamel J. Calcaneal Z osteotomy for correction of subtalar hindfoot varus deformity. Oper Orthop Traumatol, 2015, 27(4): 308-316.
19. Brunner J, Anderson J, O’Malley M, et al. Physician and patient based outcomes following surgical resection of Haglund’s deformity. Acta Orthop Belg, 2005, 71(6): 718-723.
20. Boffeli TJ, Peterson MC. The Keck and Kelly wedge calcaneal osteotomy for Haglund’s deformity: a technique for reproducible results. J Foot Ankle Surg, 2012, 51(3): 398-401.
21. DeVries JG, Summerhays B, Guehlstorf DW. Surgical correction of Haglund’s triad using complete detachment and reattachment of the Achilles tendon. J Foot Ankle Surg, 2009, 48(4): 447-451.
22. Ahn JH, Ahn CY, Byun CH, et al. Operative treatment of Haglund syndrome with central Achilles tendon-splitting approach. J Foot Ankle Surg, 2015, 54(6): 1053-1056.
23. Frey C. Surgical advancements: arthroscopic alternatives to open procedures: great toe, subtalar joint, Haglund’s deformity, and tendoscopy. Foot Ankle Clin, 2009, 14(2): 313-339.
24. Schunck J, Jerosch J. Operative treatment of Haglund’s syndrome. Basics, indications, procedures, surgical techniques, results and problems. Foot and Ankle Surgery, 2005, 11(3): 123-130.
25. Jerosch J. Endoscopic calcaneoplasty. Foot Ankle Clin, 2015, 20(1): 149-165.

Chinese Journal of Reparative and Reconstructive Surgery

ENDOSCOPIC CALCANEOPLASTY FOR Haglund’s DEFORMITY WITH HINDFOOT PAIN

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