Tendon-splitting Approach for the Surgical Treatment of Haglund's Deformity and Associated Condition. Evaluation and Results
Abstract
To evaluate the results of the dorsal longitudinal tendon-splitting approach for surgical treatment of Haglund's deformity and associated conditions. 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). 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). 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. 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.