Percutaneous Resection of Haglund’s Deformity: Is Operative Treatment Really That Simple?
Haglund’s triad of insertional achilles tendinopathy, retrocalcaneal bursitis and posterior calcaneal impingement is common. Detachment of the achilles to address the pathology is common using various incision approaches and repair constructs. The postoperative recovery is protracted, however, and complications and persistent complaints in shoe wear are common.
This begs the question: Is there a better way – for at least some patients?
“Outcomes of Percutaneous Calcaneoplasty for Insertional Achilles Tendon Problems," a retrospective case series by Stefano Ferranti, MD et al., presents the results of 27 patients who underwent percutaneous calcaneoplasty using only a Shannon Burr through a 2mm incision. Simply put, the technique and postoperative protocol included:
2mm stab incision using a beaver blade over the Haglund's prominence
2mm diameter by 12mm in length Shannon burr set to 250 rpm and 50 Ncm torque
Subjective assessment under fluoroscopy for resection assessment
Immediate partial weightbearing with crutches
Return-to-normal shoe wear at 4 weeks
Return to sport at 6 weeks
Overall, at an average follow-up of 26.5 months, 84.5% of patients were completely satisfied, 7.4% were moderately satisfied and 11.1% were not satisfied. The mean verbal analogue scale for pain score decreased from 8.1 to 2.4, and the mean VISA-A score improved from 20.7 to 75.7. The three patients who were not satisfied presented with recurrence of symptoms, requiring revision surgery.
In select patients without significant achilles degeneration or calcific changes, percutaneous calcaneoplasty may afford an alternative to traditional approaches. Eleven percent of patients in this study may say otherwise, so ongoing investigation to support the minimally invasive approach is warranted.