[Tendon-splitting approach for the surgical treatment of Haglund's deformity and associated condition. Evaluation and results].

PURPOSE OF THE STUDY

To evaluate the results of the dorsal longitudinal tendon-splitting approach for surgical treatment of Haglund's deformity and associated conditions.

MATERIAL

The group comprised patients who underwent surgery for Haglund's deformity and related conditions between January 2003 and June 2007. There were 15 patients, six women and nine men, with 17 treated heels (one man and one woman had bilateral surgery).

METHODS

Using the tendon-splitting approach, a prominence of the posteriosuperior border of the calcaneus was resected and the associated conditions were treated. The evaluation was based on a 1-to-5-degree scale and included the patient's clinical state before and after surgery (pain, shoe-wearing and load tolerance), and pre-operative radiography (presence of Haglund's deformity, ossification of the Achilles tendon and/or adjacent tissues). The study was retrospective.

RESULTS

The average age of the patients at the time of surgery was 44.5 years (range, 16 to 60). The minimum follow-up was 6 months (range, 6 to 65 months). X-ray and intra-operative findings showed Haglund's deformity in 13 cases, calcaneal bursitis in six, ossified mass at the insertion of the Achilles tendon in six, intratendinous ossification in two, and partial tendon degeneration and subcutaneous bursitis in one case each. Post-operative relief was recorded in 16 treated heels. The condition in one patient deteriorated, as manifested by heel swelling after exercise and a feeling of tension at the insertion site of the Achilles tendon in forced dorsiflexion of the ankle. An average preoperative score of 4.1 improved to 2.1 post-operatively. No serious complications either overall or at the site of surgery (Achilles tendon rupture, poor wound healing) were found. Three heels retained a slight restriction of motion (up to 10 degrees). One heel showed impaired sensitivity in the region treated.

DISCUSSION

The tendon-splitting approach provides a good view of and easy access to the structures to be operated on. The risk of incomplete resection of the prominence or of leaving sharp edges because of an insufficient view is small. Compared with other methods, this approach allows for concurrent treatment of other conditions that may be present at the insertion site of the Achilles tendon. The tendon-splitting approach does not result in any structural changes of the Achilles tendon.

CONCLUSIONS

The dorsal longitudinal tendon-splitting approach for surgical treatment of Haglund's deformity is an efficient, undemanding and safe method alternative to lateral or medial approaches used more often. It allows for concurrent treatment of several pathological conditions at the insertion site of the Achilles tendon, such as subcutaneous bursitis, ossified mass at the tendon insertion, tendon degeneration, intratendinous ossification, calcaneal bursitis and Haglund's deformity.