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Coccidioidal osteomyelitis is difficult to diagnose. Confirmation depends on culture and histopathological examination. This rare type of fungal osteomyelitis is to be considered in the differential diagnosis of a chronic infection in some areas of the world. Specific treatment with excision and amphotericin-B can be effective.

A BS T R A C T BACKGROUNDHaglund syndrome is defined as the complex of symptoms involving the superolateral calcaneal prominence, retrocalcaneal bursitis and superficial adventitious Achillis tendon bursitis. The purpose of our study is to evaluate endoscopic treatment of Haglund's syndrome in which all patients showed a Haglund projection on radiography and none had a cavovarus deformity. METHODSOur study included 24 patients (30 heels) with a mean age of 32 yrs. (range 26-44 yrs.). They presented with posterior ankle impingement syndrome with Haglund's deformity on radiography and were resistant to conservative therapy for more than 6 months. They underwent two-portal endoscopic surgery in SCBMC & H between July 2016 and Dec. 2019. The inflamed bursa and posterosuperior surface of the calcaneus were removed with a shaver and bone resection performed until there was no friction on the Achilles tendon with the ankle in dorsiflexion. All patients were evaluated pre-operatively and postoperatively with parallel pitch lines, the American Orthopaedic Foot and Ankle Society (AOFAS) score, the visual analogue scale (VAS) for pain and the Ogilvie Harris score. The surgical time, time to return to day to day activity, patient satisfaction and any complications related to the surgery were assessed. All patients were discharged on the 2nd day and full weight-bearing was allowed from second postoperative week. RESULTSThe mean follow-up was 24 months (range 6-41 months). In 27 heels, postoperatively we achieved negative parallel pitch lines on lateral radiographs. The average AOFAS score improved from 59.3 ± 9.9 points pre-operatively to 94.8 ± 9.1 points at final evaluation (p<0.01). There were sixteen excellent results, ten good results, two fair results and two poor results. For the Ogilvie Harris score, there were seventeen excellent, ten good, one fair, and two poor results. The VAS for pain decreased from 6.8 ± 1.4 (range 5 -10) preoperatively to 1.8 ± 0.8 (range 0-4) (p<0.01) at final evaluation. There was no obvious intra or post-operative complications. All patients were satisfied with the results of the operation. CONCLUSIONSEndoscopic calcaneoplasty is a safe and effective minimally invasive treatment option for Haglund disease after failure of conservative treatment for 6 months.

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