Abstract
Purpose
The aim of this research is to report the clinical outcome following surgical correction of Haglund’s deformity summarising different surgical strategies and comparing clinical outcomes, failures, complications and return to activities of patients underwent open and endoscopic techniques.
Methods
A systematic search of the literature was conducted using eight different databases. Thirty-five studies were included in the systematic review. A total of 1260 ankles of 1147 patients were grouped in accordance with the surgical approach (open, endoscopic, or percutaneous).
Results
The overall mean age was 44.8 ± 8.2 (range 14.9–82) years with a mean follow-up of 30.9 ± 17.1 (range 3–132) months. Analysis of clinical outcomes of open and endoscopic techniques demonstrated significant differences of AOFAS (87.1 ± 5.9 versus 90.7 ± 4.2 points; P < 0.001), complications (15.5% versus 4.1%; P < 0.001), failures (6.0% versus 1.2%; P < 0.001), time to return to daily activities (17.2 ± 9.3 versus 6.3 ± 1.0 weeks; P < 0.001) and time to return to sport (20.7 ± 3.3 versus 11.9 ± 0.3 weeks; P < 0.001) in the studies that reported these specific outcome measures.
Conclusion
Surgical correction of Haglund’s deformity provides overall good clinical results and high subjective satisfaction. Endoscopic procedures demonstrated better final AOFAS, a lower rate of complications and failures, and shorter recovery time when compared to open techniques.
Level of evidence
Level IV.
Similar content being viewed by others
References
Ahn JH, Ahn CY, Byun CH, Kim YC (2015) Operative treatment of Haglund syndrome with central Achilles tendon-splitting approach. J Foot Ankle Surg 54:1053–1056. https://doi.org/10.1053/j.jfas.2015.05.002
Aldahshan W, Elsherief F, Elbehairy HF, Abdelaziz AM (2017) Endoscopic calcaneoplasty for treatment of Haglund’s syndrome. Egypt Orthop J 53(2):107–112
Allam MT, Fadel ME, Quolquela MA, Samy AM (2019) Surgical resection of Haglund’s deformity by Achilles tendon splitting approach. Med J Cairo Univ 87:3451–3458
Anderson JA, Suero E, O’Loughlin PF, Kennedy JG (2008) Surgery for retrocalcaneal bursitis: a tendon-splitting versus a lateral approach. Clin Orthop Relat Res 466:1678–1682. https://doi.org/10.1007/s11999-008-0281-9
Appala Raju S, Rajasekhara Rao G, Vijayabhushanam M, Venkateswara RM, Anil B (2015) Comparision of open versus endoscopic calcaneoplasty for haglunds deformity: a short term analysis. J Evol Med Dent Sci 4(12):1950–1954
Basran SS, Sajid I, Bansal P (2018) Endoscopic management of patients with Haglund’s disease: a prospective study. J Bone Joint Dis 33(1):31–34
Brunner J, Anderson J, O’Malley M, Bohne W, Deland J, Kennedy J (2005) Physician and patient based outcomes following surgical resection of Haglund’s deformity. Acta Orthop Belg 71:718–723
Calder JD, Saxby TS (2003) Surgical treatment of insertional Achilles tendinosis. Foot Ankle Int 24:119–121. https://doi.org/10.1177/107110070302400203
Chen CH, Huang PJ, Chen TB, Cheng YM, Lin SY, Chiang HC, Huang CY, Huang CK (2001) Surgical treatment for Haglund’s deformity. Kaohsiung J Med Sci 17:419–422
Clancy WG (1980) Runners’ injuries. Part two. Evaluation and treatment of specific injuries. Am J Sports Med 8:287–289. https://doi.org/10.1177/036354658000800415
Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J (2019) Updated guidance for trusted systematic reviews a new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev 10:142. https://doi.org/10.1002/14651858.ED000142
DeVries JG, Summerhays B, Guehlstorf DW (2009) Surgical correction of Haglund’s triad using complete detachment and reattachment of the Achilles tendon. J Foot Ankle Surg 48:447–451. https://doi.org/10.1053/j.jfas.2009.03.004
Ewais WM, Romeih MA (2017) Hind-foot endoscopic decompression of the retrocalcaneal space as an appropriate treatment for refractory Haglund’s syndrome. Egypt Orthop J 52(3)
Georgiannos D, Lampridis V, Vasiliadis A, Bisbinas I (2017) Treatment of insertional Achilles pathology with dorsal wedge calcaneal osteotomy in athletes. Foot Ankle Int 38:381–387. https://doi.org/10.1177/1071100716681139
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ, Group GW (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926. https://doi.org/10.1136/bmj.39489.470347.AD
Haglund P (1928) Beitrag zur Klinik der Achillessehne. Zeitschr Orthop Chir 49:49–58
Hardy A, Rousseau R, Issa SP, Gerometta A, Pascal-Moussellard H, Granger B, Khiami F (2018) Functional outcomes and return to sports after surgical treatment of insertional Achilles tendinopathy: surgical approach tailored to the degree of tendon involvement. Orthop Traumatol Surg Res 104:719–723. https://doi.org/10.1016/j.otsr.2018.05.003
Iversen JV, Bartels EM, Langberg H (2012) The victorian institute of sports assessment—achilles questionnaire (visa-a)—a reliable tool for measuring achilles tendinopathy. Int J Sports Phys Ther 7:76–84
Jerosch J (2015) Endoscopic calcaneoplasty. Foot Ankle Clin 20:149–165. https://doi.org/10.1016/j.fcl.2014.10.004
Jerosch J, Nasef NM (2003) Endoscopic calcaneoplasty–rationale, surgical technique, and early results: a preliminary report. Knee Surg Sports Traumatol Arthrosc 11:190–195. https://doi.org/10.1007/s00167-003-0365-8
Jerosch J, Schunck J, Sokkar SH (2007) Endoscopic calcaneoplasty (ECP) as a surgical treatment of Haglund’s syndrome. Knee Surg Sports Traumatol Arthrosc 15:927–934. https://doi.org/10.1007/s00167-006-0279-3
Jiang Y, Li Y, Tao T, Li W, Zhang K, Gui J, Ma Y (2016) The double-row suture technique: a better option for the treatment of haglund syndrome. Biomed Res Int 2016:1895948. https://doi.org/10.1155/2016/1895948
Kaynak G, Öğüt T, Yontar NS, Botanlıoğlu H, Can A, Ünlü MC (2013) Endoscopic calcaneoplasty: 5 year results. Acta Orthop Traumatol Turc 47:261–265. https://doi.org/10.3944/aott.2013.3003
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353. https://doi.org/10.1177/107110079401500701
Kondreddi V, Gopal RK, Yalamanchili RK (2012) Outcome of endoscopic decompression of retrocalcaneal bursitis. Indian J Orthop 46:659–663. https://doi.org/10.4103/0019-5413.104201
Labib SA, Pendleton AM (2012) Endoscopic calcaneoplasty: an improved technique. J Surg Orthop Adv 21:176–180. https://doi.org/10.3113/jsoa.2012.0176
Langley GB, Sheppeard H (1985) The visual analogue scale: its use in pain measurement. Rheumatol Int 5:145–148. https://doi.org/10.1007/bf00541514
Leitze Z, Sella EJ, Aversa JM (2003) Endoscopic decompression of the retrocalcaneal space. J Bone Joint Surg Am 85:1488–1496. https://doi.org/10.2106/00004623-200308000-00009
Lin HA, Chong HA, Yeo W (2014) Calcaneoplasty and reattachment of the Achilles tendon for insertional tendinopathy. J Orthop Surg (Hong Kong) 22:56–59. https://doi.org/10.1177/230949901402200115
Lu CC, Cheng YM, Fu YC, Tien YC, Chen SK, Huang PJ (2007) Angle analysis of Haglund syndrome and its relationship with osseous variations and Achilles tendon calcification. Foot Ankle Int 28:181–185. https://doi.org/10.3113/FAI.2007.0181
Lui TH (2016) Endoscopic calcaneoplasty and achilles tendoscopy with the patient in supine position. Arthrosc Tech 5:e1475–e1479. https://doi.org/10.1016/j.eats.2016.08.027
Lui TH, Lo CY, Siu YC (2019) Minimally invasive and endoscopic treatment of haglund syndrome. Foot Ankle Clin 24:515–531. https://doi.org/10.1016/j.fcl.2019.04.006
Madarevic T, Rakovac I, Ruzic L, Tudor A, Gudac Madarevic D, Prpic T, Sestan B (2014) Ultrasound-assisted calcaneoplasty. Knee Surg Sports Traumatol Arthrosc 22:2250–2253. https://doi.org/10.1007/s00167-013-2692-8
Maffulli N, Denaro V, Loppini M (2012) Haglunds deformity. In: Foot Ankle Int, vol 33. vol 9. United States, pp 807–808; author reply 808. https://doi.org/10.3113/fai.2012.0807
Mansour MM (2017) Endoscopic versus open treatment of Haglund’s syndrome. Egypt Orthop J 52:190–194
McGarvey WC, Palumbo RC, Baxter DE, Leibman BD (2002) Insertional Achilles tendinosis: surgical treatment through a central tendon splitting approach. Foot Ankle Int 23:19–25. https://doi.org/10.1177/107110070202300104
Michels F, Guillo S, King A, Jambou S, de Lavigne C (2008) Endoscopic calcaneoplasty combined with Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc 16:1043–1046. https://doi.org/10.1007/s00167-008-0602-2
Mir NA, Ali N, Khan K, Dar TA, Khandy RI, Dhar SA (2018) Surgical resection of Haglund deformity by lateral approach: our institutional experience on 29 heels. Int J Res Orthop 4(4):595–600
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005
Natarajan S, Narayanan VL (2015) Haglund deformity—surgical resection by the lateral approach. Malays Orthop J 9:1–3. https://doi.org/10.5704/MOJ.1503.006
Neyisci C, Erdem Y, Bileki AB, Yurttas Y (2019) More extensile osteotomy in the treatment of posterior calcaneal osteophyte (Haglund’s disease). Med Science 8:923–926
Nilsson-Helander K, Thomee R, Silbernagel KG, Thomee P, Faxen E, Eriksson BI, Karlsson J (2007) The Achilles tendon total rupture score (ATRS): development and validation. Am J Sports Med 35:421–426. https://doi.org/10.1177/0363546506294856
Notari MA, Mittler BE (1984) An investigation of Fowler-Philip’s angle in diagnosing Haglund’s deformity. J Am Podiatry Assoc 74:486–489. https://doi.org/10.7547/87507315-74-10-486
OCEBM Levels of Evidence Working Group*. "The Oxford Levels of Evidence 2". Oxford Centre for Evidence-Based Medicine. https://www.cebm.net/index.aspx?o=5653. Accessed February 1st, 2020.
Ogilvie-Harris DJ, Mahomed N, Demazière A (1993) Anterior impingement of the ankle treated by arthroscopic removal of bony spurs. J Bone Joint Surg Br 75:437–440
Ortmann FW, McBryde AM (2007) Endoscopic bony and soft-tissue decompression of the retrocalcaneal space for the treatment of Haglund deformity and retrocalcaneal bursitis. Foot Ankle Int 28:149–153. https://doi.org/10.3113/FAI.2007.0149
Pauker M, Katz K, Yosipovitch Z (1992) Calcaneal ostectomy for Haglund disease. J Foot Surg 31:588–589
Perlman MD (1992) Enlargement of the entire posterior aspect of the calcaneus: treatment with the Keck and Kelly calcaneal osteotomy. J Foot Surg 31:424–433
Roth KE, Mueller R, Schwand E, Maier GS, Schmidtmann I, Sariyar M, Maus U (2014) Open versus endoscopic bone resection of the dorsolateral calcaneal edge: a cadaveric analysis comparing three dimensional CT scans. J Foot Ankle Res 7:56. https://doi.org/10.1186/s13047-014-0056-3
Sammarco GJ, Taylor AL (1998) Operative management of Haglund’s deformity in the nonathlete: a retrospective study. Foot Ankle Int 19:724–729. https://doi.org/10.1177/107110079801901102
Sanders R, Fortin P, DiPasquale T, Walling A (1993) Operative treatment in 120 displaced intraarticular calcaneal fractures. results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 290:87–95
Schneider W, Niehus W, Knahr K (2000) Haglund’s syndrome: disappointing results following surgery—a clinical and radiographic analysis. Foot Ankle Int 21:26–30. https://doi.org/10.1177/107110070002100105
Scholten PE, van Dijk CN (2006) Endoscopic calcaneoplasty. Foot Ankle Clin 11:439–446, viii. https://doi.org/10.1016/j.fcl.2006.02.004
Sella EJ, Caminear DS, McLarney EA (1998) Haglund’s syndrome. J Foot Ankle Surg 37:110–114. https://doi.org/10.1016/s1067-2516(98)80089-6 ((discussion 173))
Sergio F, Catani O, Fusini F, Langella F, Cautiero G, Ponzo I, Zanchini F (2018) Treating Haglund’s Deformity with percutaneous Achilles tendon decompression: a case series. Muscles, Ligaments and Tendons J 8:488–494
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x
Stephens MM (1994) Haglund’s deformity and retrocalcaneal bursitis. Orthop Clin North Am 25:41–46
Sundararajan PP, Wilde TS (2014) Radiographic, clinical, and magnetic resonance imaging analysis of insertional Achilles tendinopathy. J Foot Ankle Surg 53:147–151. https://doi.org/10.1053/j.jfas.2013.12.009
Syddall HE, Martin HJ, Harwood RH, Cooper C, Aihie Sayer A (2009) The SF-36: a simple, effective measure of mobility-disability for epidemiological studies. J Nutr Health Aging 13:57–62. https://doi.org/10.1007/s12603-009-0010-4
Syed TA, Perera A (2016) A proposed staging classification for minimally invasive management of haglund’s syndrome with percutaneous and endoscopic surgery. Foot Ankle Clin 21:641–664. https://doi.org/10.1016/j.fcl.2016.04.004
Taylor GJ (1986) Prominence of the calcaneus: is operation justified? J Bone Joint Surg Br 68:467–470
Tourne Y, Baray AL, Barthelemy R, Moroney P (2018) Contribution of a new radiologic calcaneal measurement to the treatment decision tree in Haglund syndrome. Orthop Traumatol Surg Res 104:1215–1219. https://doi.org/10.1016/j.otsr.2018.08.014
Vaishya R, Agarwal AK, Azizi AT, Vijay V (2016) Haglund’s syndrome: a commonly seen mysterious condition. Cureus 8:e820. https://doi.org/10.7759/cureus.820
van Dijk CN (2006) Hindfoot endoscopy for posterior ankle pain. Instr Course Lect 55:545–554
van Dijk CN, van Dyk GE, Scholten PE, Kort NP (2001) Endoscopic calcaneoplasty. Am J Sports Med 29:185–189. https://doi.org/10.1177/03635465010290021101
van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N (2011) Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc 19:835–841. https://doi.org/10.1007/s00167-010-1374-z
van Sterkenburg MN, Groot M, Sierevelt IN, Spennacchio PA, Kerkhoffs GM, van Dijk CN (2011) Optimization of portal placement for endoscopic calcaneoplasty. Arthroscopy 27:1110–1117. https://doi.org/10.1016/j.arthro.2011.02.030
Vega J, Baduell A, Malagelada F, Allmendinger J, Dalmau-Pastor M (2018) Endoscopic Achilles Tendon Augmentation With Suture Anchors After Calcaneal Exostectomy in Haglund Syndrome. Foot Ankle Int 39:551–559. https://doi.org/10.1177/1071100717750888
Watson AD, Anderson RB, Davis WH (2000) Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional achilles tendinosis with calcific spur. Foot Ankle Int 21:638–642. https://doi.org/10.1177/107110070002100802
Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, Sierevelt IN, van Dijk CN (2013) Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc 21:1345–1355. https://doi.org/10.1007/s00167-012-2219-8
Wu Z, Hua Y, Li Y, Chen S (2012) Endoscopic treatment of Haglund’s syndrome with a three portal technique. Int Orthop 36:1623–1627. https://doi.org/10.1007/s00264-012-1518-5
Xia Z, Yew AKS, Zhang TK, Su HCD, Ng YCS, Rikhraj IS (2017) Surgical correction of Haglund’s triad using a central tendon-splitting approach: a retrospective outcomes study. J Foot Ankle Surg 56:1132–1138. https://doi.org/10.1053/j.jfas.2017.05.015
Funding
No funding to declare.
Author information
Authors and Affiliations
Contributions
Mattia Alessio-Mazzola and Antonio Russo: reviewers and draft writers; Andrea Giorgio Capello and Stefano Lovisolo, data analysis, editing of results section; Matteo Formica and Ilaria Repetto, draft review, editing of discussion section; Lamberto Felli, final manuscript review, grammar and language editing.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Ethical approval
This article does not contain any studies with human participants performed by any of the authors.
Informed consent
For this type of study formal consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Alessio-Mazzola, M., Russo, A., Capello, A.G. et al. Endoscopic calcaneoplasty for the treatment of Haglund’s deformity provides better clinical functional outcomes, lower complication rate, and shorter recovery time compared to open procedures: a systematic review. Knee Surg Sports Traumatol Arthrosc 29, 2462–2484 (2021). https://doi.org/10.1007/s00167-020-06362-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-020-06362-1