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Haglund's Deformity Resection
- synonyms: calcaneal prominence resection
CPT
Indications
- Painful Haglund's deformity that fails to improve with 6 months of non-operative treatment.
Contraindications
- Infection
- Open wound / Blister
- Periperal Vascular disease
Alternatives
- Non-operative treatment
- Endoscopic Resection
Pre-op Planning / Special Considerations
- Lateral and or medial incisions may be used. Single lateral incisions decrease risk of injury to medial calcaneal sensory nerve and wound problems.
- As much as 50% of the insertion of the Achilles tendon can be safely resected. (Kolodziej P, Foot Ankle Int 1999;20:433).
Technique
- Pre-operative antibiotics, +/- regional block
- General endotracheal anesthesia
- Prone position with bulster under leg. All bony prominences well padded.
- Prep and drape in standard sterile fashion.
- 8cm-longitudinal incision just anterior to the lateral aspect of the Achilles tendon.
- Expose retrocalcaneal bursa and posterior-superior calcaneous.
- Perfom oblique osteotomy with oscillating saw from the superior angle of the calcaneous @1.5cm anterior to the posterior border of the calcaneous and angling downward to the Achilles insertion @2cm distal to the superior margin of the calcaneous.
- Ensure to ridge of bone is left that will irritate the Achilles. Consider using microreciprocating rasp.
- Palpate the area of prior prominence throught the overlying skin ensuring all prominences are removed.
- Longitudinal incision in the anterior 50% of the Achilles is made and the tendon is inspected for necrotic areas and debrided as indicated.
- Repair Achilles tendon with buried 3-0 non-absorable suture (Ethibond).
- Irrigate.
- Close in layers.
- Place in bulky-Jones splint in mild equines. Non-weight bearing
Complications
- Achilles tendon laceration or avulsion
- Persistent posterior heel pain
- Wound breakdown
- Medial calcaneal sensory nerve injury
- Sural nerve injury
- Ankle stiffness
- Insicional neuroma
Follow-up care
- At 1-2 week follow-up: short-leg walking cast in neutral vs mild equines depending on status of Achilles tendon at surgery.
- At 4 weeks: 1/2 inch heel lift, weight-bearing as tolerated with activity limitations
- At 3 months: resume normal activities.
- Full recovery is typically prolonged and takes 6-12 months.
Outcomes
- (Sammarco GJ, Foot Ankle Int 1998;19:724).
- (Schneider W, Foot Ankle Int 2000;21:26).
Review References
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