Surgical Management of Insertional Achilles Tendinopathy with Haglund's Deformity: A Preliminary Report

Jun-Young Lee; Sueng-Hwan Jo; Hoon Yang

doi:10.4055/jkoa.2010.45.5.356

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Lee, Jo, and Yang: Surgical Management of Insertional Achilles Tendinopathy with Haglund's Deformity: A Preliminary Report

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(5): 356-362.

Published online: 31 October 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.5.356

Surgical Management of Insertional Achilles Tendinopathy with Haglund's Deformity: A Preliminary Report

Jun-Young Lee, M.D., Sueng-Hwan Jo, M.D., Hoon Yang, M.D.

Department of Orthopedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Correspondence to: Jun-Young Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Chosun University, 588, Seosuk-dong, Dong-gu, Gwangju 501-717, Korea. TEL: +82-62-220-3147, FAX: +82-62-226-3379, leejy88@chosun.ac.kr

Received 2 November 2009 Accepted 22 July 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We wanted to report on treatment outcomes in insertional Achilles tendinopathy patients with Haglund's deformity that were operated on using a central achilles tendon splitting approach.

Materials and Methods

We enrolled six cases of insertional tendinopathy with concomitant Haglund's disease who underwent an operation between January, 2007 and November, 2008 and for whom follow-up duration for more than 1 year were available. The mean age was 41.5 (21-62) years; the mean follow-up period was 16.3 (12-24) months. Resection of retrocalcaneal bony prominences and inflamed bursa with debridement of degenerative tendons was done using central splitting approach in all cases. A lateral ankle radiograph was used to assess the amount of bony resection. Clinical and functional evaluations were done before and after the operation.

Results

In all cases, retrocalcaneal bony prominences were completely resected. Clinical and functional outcomes were significantly improved. One case had a mild tingling distal to the operative lesion. There were no other complications.

Conclusion

A central splitting approach is an efficient procedure that can provide sufficient exposure to remove pathologic lesions in patients with insertional Achilles tendinopathy accompanying Haglund's disease.

Keywords: achilles tendon, insertional achilles tendinopathy, Haglund's deformity, central splitting approach

Figures and Tables

Figure 1

A 35-year-old male patient. (A) Lateral radiograph shows prominent posterior tuberosity of the calcaneus (Haglund deformity). (B) Postoperative radiograph demonstrates resection of posterior tuberosity superior to dorsal aspect of Achilles insertion, and tendon fixation with suture anchors.

Figure 2

Intraoperative photographs. (A) The central split approach of the Achilles tendon. (B) Resection of tuberosity. (C) After completion of bone resection and debridement, the suture anchor was fixed for reattachment of distal portion of the Achilles tendon.

Table 1

Summary of Cases

^*Pre, Pre-operation; ^†Post, Post-operation; ^‡Shoewear, patients had pain when walking barefoot, or pain with shoewear, or no pain with shoewear; ^§Limitations of work, patients were unable to work full-time or at all because of pain.

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