Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

Abstract

Background: Haglund syndrome is a common disease that causes posterior heel pain. This study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence resection (PPR) for the treatment of Haglund syndrome. Methods: This retrospective study included 12 patients who underwent DCWCO and 32 patients who underwent PPR from January 2010 to August 2016. Patients were evaluated using the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), Victorian Institute of Sport Assessment Scale for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler's angle, and calcaneal pitch angle preoperatively and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up). Results: Both groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery. The DCWCO group had lower AOFAS scores than the PPR group at 6 months (77.6 ± 5.1 vs. 82.8 ± 7.8; P = 0.037) but had higher scores at the latest follow-up (98.2 ± 2.3 vs. 93.4 ± 6.1; P = 0.030). The DCWCO group had lower VISA-A scores at 3 months (56.9 ± 13.9 vs. 65.2 ± 11.0; P = 0.044) but higher scores at the latest follow-up (98.2 ± 2.6 vs. 94.3 ± 5.0; P = 0.010) than the PPR group. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler's angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group (35.9°± 4.9°vs. 31.4°± 6.2°; P = 0.026). However, there was no statistically significant difference in any other angle of the two groups postoperatively. Conclusions: Compared to the PPR group, the DCWCO group had poorer short-term clinical outcomes but provide better long-term function and symptom remission. This method can be a good option for those patients with higher functional expectations.

Surgical Treatment of Haglund’s Deformity: A Systematic Review and Meta-Analysis

“…For open surgeries, three main approaches were used. They were the lateral approach [4,7,10,14,15,17,[19][20][21]23], medial approach [4,21,24], and midline Achilles tendon central split approach [5,17,22]. There were two studies that utilized the dorsal closing wedge osteotomy technique [7,23].…”

Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems

“…7 Values of FPa greater than 75 degrees are suggestive of Haglund deformity. 10 At last follow-up, they evidenced a significant improvement of the AOFAS and reduction of the VAS scores, along with a normalization of the FPa within the physiological range. They concluded that percutaneous treatment for Haglund deformity is reliable and effective at approximately 17 months' follow-up.…”

Management of Insertional Achilles Tendinopathy

“…An alternative to the above techniques that require excision of bursa, degenerative tendon, and bony prominences is a dorsal closing wedge osteotomy of the calcaneus anterior to the Haglund deformity, known as the Zadek osteotomy. [34][35][36][37] The dorsal closing wedge osteotomy relocates the insertion of the Achilles anterior and proximal and tilts the Haglund prominence away from the tendon, theoretically decreasing the friction of the tendon against the prominence. Maffulli et al 34 demonstrated on 28 patients a 100% healing rate of the osteotomy and improved outcome scores at 24 months.…”