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Haglund's Deformity Resection 28120

 

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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