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. 2024 Nov 29;16(11):e74713.
doi: 10.7759/cureus.74713. eCollection 2024 Nov.

Functional Outcomes Following Partial Osteotomy of the Calcaneal Tuberosity for Haglund's Syndrome

Saran Karthik S  1 , Pradeep Elangovan  2 , Akshaya Sekar  3 , Praveena Daya A  3 , Vinod Kumar C  1 , Vibishek Raj P  4 , Ashwin Vy  2
Affiliations

Functional Outcomes Following Partial Osteotomy of the Calcaneal Tuberosity for Haglund's Syndrome

Saran Karthik S et al. Cureus. .

Abstract

Background Haglund's syndrome, a common cause of pain in the posterior heel that consists of painful swelling of the local soft tissues and prominence of the posterosuperior calcaneal projection, presents significant challenges in treatment, particularly when conservative management fails. This study evaluates the functional outcomes following oblique partial excision of the posterosuperior portion (calcaneal tuberosity osteotomy) of the calcaneus for Haglund's syndrome. Methods A cohort of 30 patients, aged 18 years and older, with persistent heel pain unresponsive to conservative treatments, underwent partial osteotomy using a medial or lateral approach. Patients were assessed pre-operatively and post-operatively at six weeks, three months, and six months using the American Orthopedic Foot and Ankle Society (AOFAS) scoring system. Data were analyzed using descriptive statistics and the Friedman test to evaluate changes in AOFAS scores over time. Results The mean AOFAS score improved significantly from 55.17 pre-operatively to 79.27 at six months post-operatively. At six months, 16 (53.3%) participants had AOFAS scores between 80-89, indicating good functional outcomes, while 14 (46.7%) had scores between 70-79. The improvement in functional outcomes was statistically significant (p < 0.001). The study also found both lateral and medial surgical approaches yielded similar results. Conclusion Partial osteotomy of the calcaneal tuberosity is a safe and effective surgical intervention for Haglund's syndrome, leading to significant functional improvements. The use of AOFAS scoring provides a reliable assessment of outcomes, confirming the procedure's efficacy.

Keywords: american orthopedic foot and ankle society (aofas) ankle /hindfoot score; bursitis; bursitis-surgery; calcaneus-surgery; haglund's syndrome; haglund’s deformity; osteotomy-methods; retrocalcaneal bursitis.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Human Ethics Committee, Chettinad Academy of Research and Education issued approval 012/IHEC/Feb.2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Radiological evaluations
Parallel pitch lines (PPL), calcaneal pitch angle (α), and Fowler’s angle (β)
Figure 2
Figure 2. Case 1 details
a: pre-op image showing the presence of tender bony prominence at tendo Achilles insertion; b: measurement of Fowler angle (a), calcaneal pitch angle (b), parallel pitch lines (PPL) showing abnormal bursal projection above upper PPL; c: intra-op image showing lateral approach; d: post-operative radiograph showing adequate bone resection below upper parallel pitch line
Figure 3
Figure 3. Case 2 details
a: pre-op image showing presence of tender bony prominence at tendo Achilles insertion; b: intra-op image showing lateral approach; c: pre-op X-ray showing measurement of Fowler angle (a), calcaneal pitch angle (b), parallel pitch lines (PPL) showing abnormal bursal projection above upper PPL; d: post-op radiograph showing adequate bone resection below upper PPL
See this image and copyright information in PMC

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