Classification for Haglund’s Syndrome (Deformity)

Cover Page

Abstract

The objective of the study — to propose a classification for Haglund’s syndrome based on the differentiated treatment outcomes and to conduct a systematic review of articles on this topic.

Materials and Methods. The article based on the diagnosis and treatment of 77 patients with Haglund’s syndrome. 68 patients with Haglund’s syndrome underwent surgery (79 operations), 14 of which were endoscopic. In 9 patients conservative treatment techniques were undertaken.

Results. As a result of analyzing a variety of cases of Haglund’s syndrome, we proposed clinical and morphological classifications for Haglund’s syndrome that help to choose the optimal treatment tactics. according to its clinical form, Haglund’s deformity may be common, atypical, and “hiding”. A special clinical variation is a cosmetic form. Depending on morphological characteristics, it was proposed to distinguish upper, upper-lateral, “arc type”, total types, and atypical variations. With the upper type of deformity and, rarely, with the upper-lateral one, an endoscopic technique or minimally invasive surgical correction is preferable. For more extensive variants, the only solution should be an open procedure. The outcomes at 11.5±1.2 months after surgery showed significant improvement in patient condition as compared to the preoperative status (p<0.001). On the AOFAS, the scores were 92.2±3.1 after open procedures (86.1±3.5 and 93.2±2.2 for the different types) and 94.7±1.8 after endoscopic operations. However, we cannot speak confidently of the advantage of endoscopic surgery, since adequate resection during the endoscopic operation is possible only in limited cases of the Haglund’s deformity types (upper and upper-lateral). For the same reason, it is impossible to compare the results of minimally invasive surgery with fluoroscopic control with the results of open surgical intervention. according to AOFAS (p<0.001), conservative treatment also improved the status of patients, more specifically from 75.1±4.7 to 80.1±5.7. However these improvements were significantly less compared to surgical treatment (p<0.001). Our results of patient treatment were included in an updated systematic review of twenty-eight studies related to the results of open (681 patients in total) and endoscopic (321 patients in total) treatment of patients with Haglund’s syndrome.

Conclusion. Particular attention should be paid to the “hiding” clinical cases which do not manifest signs of tenopathy, but are detrimental to athletic performance. We consider treatment strategy based on clinical and morphological classifications as justified, when the type of operation (open, minimally invasive or endoscopic) was determined by the type of deformity and its localization.

About the authors

A. P. Sereda

Federal Medical and Biological Agency

Author for correspondence.
Email: drsereda@gmail.com

Andrey P. Sereda — Dr. Sci. (Med.), deputy head

Moscow Russian Federation

A. M. Belyakova

Burnazyan Federal Medical Biophysical Center of Federal Medical Biological Agency

Email: fake@neicon.ru

Anna M. Belyakova – orthopedic surgeon

Moscow

Russian Federation

References

  1. Середа А.П., Кавалерский Г.М. Синдром Хаглунда: историческая справка и систематический обзор. Травматология и ортопедия России. 2014;(1):122-132.
  2. Pavlov H., Heneghan M.A., Hersh A., Goldman A.B., Vigorita V. The Haglund syndrome: initial and differential diagnosis. Radiology. 1982;144(1):83-88. doi: 10.1148/radiology.144.1.7089270.
  3. Sella E.J., Caminear D.S., Mclarney E.A. Haglund’s syndrome. J Foot Ankle Surg. 1998;37(2):110-114.
  4. Lohrer H., Nauck T., Dorn N.V., Konerding M. A Comparison of endoscopic and open resection for Haglund tuberosity in a cadaver study. Foot Ankle Int. 2006;27(6):445-450. doi: 10.1177/107110070602700610.
  5. Terminologia anatomica: International anatomical Terminology. New york: Thieme Medical Publishers. 1998. P. 45.
  6. Kondreddi V., Gopal R.K., Yalamanchili R.K. Outcome of endoscopic decompression of retrocalcaneal bursitis. Indian J Orthop. 2012;46(6):659-663. doi: 10.4103/0019-5413.104201.
  7. Madarevic T., Rakovac I., Ruzic l., Tudor A., Gudac Madarevic D., Prpic T., Sestan B. Ultrasound-assisted calcaneoplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22(9):2250-2253. doi: 10.1007/s00167-013-2692-8.
  8. Ortmann F.W., Mcbryde A.M. Endoscopic bony and soft-tissue decompression of the retrocalcaneal space for the treatment of Haglund deformity and retrocalcaneal bursitis. Foot Ankle Int. 2007;28(2):149-153. doi: 10.3113/faI.2007.0149.
  9. Kang S., Thordarson D.B., Charlton T.P. Insertional achilles tendinitis and Haglund’s deformity. Foot Ankle Int. 2012;33(6):487-491. doi: 10.3113/faI.2012.0487.
  10. van Dijk C.N., Van Sterkenburg M.N., Wiegerinck J.I., Karlsson J., Maffulli N. Terminology for achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19(5):835-841. doi: 10.1007/s00167-010-1374-z.
  11. Ефименко Н.А., Грицюк А.А., Середа А.П. Диагностика разрывов ахиллова сухожилия. Клиническая медицина. 2011;89(3):64-70.
  12. Середа А.П., Мойсов А.А., Сметанин С.М. Плантарный фасциит: диагностика и лечение. Сибирский медицинский журнал (Иркутск). 2016;143(4):5-9.
  13. Тучков В.Е., Суздалева И.А., Кузнецова О.В., Самойлов А.С., Середа А.П. Кинезиологическое тейпирование в лечебной практике. М.: ФМБЦ им. А. И. Бурназяна, 2017. 80 с.
  14. Sammarco G.J., Taylor A.L. Operative management of Haglund’s deformity in the nonathlete: a retrospective study. Foot Ankle Int. 1998;19(11):724-729. doi: 10.1177/107110079801901102.
  15. Qi J., Gong L., Liu J., Li Y., Li Q. [Endoscopic calcaneoplasty for Haglund’s deformity with hindfoot pain]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016;30(6):700-704. doi: 10.7507/1002-1892.20160142. (In Chinese).
  16. Mattila V.M., Sillanpää P.J., Salo T., Laine H.J., Mäenpää H., Pihlajamäki H. Can orthotic insoles prevent lower limb overuse injuries? a randomized-controlled trial of 228 subjects. Scand J Med Sci Sports. 2011;21(6): 804-808. doi: 10.1111/j.1600-0838.2010.01116.x.
  17. Aliyev R., Muslimov Q., Geiger G. Results of conservative treatment of achillodynia with application microcurrent therapy. Georgian Med News. 2010;(187): 35-42.
  18. Карданов А.А., Буали Н.М., Русанова В.В., Непомящий И.С. Результаты хирургического лечения болезни Хаглунда. Травматология и ортопедия России. 2013;(1):67-71. doi: 10.21823/2311-2905-2013--1-67-71.
  19. Anderson J.A., Suero E., O’Loughlin P.F., Kennedy J.G. Surgery for retrocalcaneal bursitis: a tendon-splitting versus a lateral approach. Clin Orthop Relat Res. 2008;466(7):1678-1682. doi: 10.1007/s11999-008-0281-9.
  20. Angermann P. Chronic retrocalcaneal bursitis treated by resection of the calcaneus. Foot Ankle. 1990;10(5):285-287.
  21. Brunner J., Anderson J., O’Malley M., Bohne W., Deland J., Kennedy J. Physician and patient based outcomes following surgical resection of Haglund’s deformity. Acta Orthop Belg. 2005;71(6):718-723.
  22. Chen C.H., Huang P.J., Chen Т.В., Cheng Y.M., Lin S.Y., Chiang H.C. et al. Surgical treatment for Haglund’s deformity. Kaohsiung J Med Sci. 2001;17(8):419-422.
  23. Biyani A., Jones D.A. Results of excision of calcaneal prominence. Acta Orthop Belg. 1993;59(1):45-49.
  24. Lehto M.U., Jarvinen M., Suominen P. Chronic achilles peritendinitis and retrocalcanear bursitis. Knee Surg Sports Traumatol Arthrosc. 1994;2(3):182-185.
  25. Leitze Z., Sella E.J., Aversa J.M. Endoscopic decompression of the retrocalcaneal space. J Bone Joint Surg Am. 2003;85(8):1488-1496. doi: 10.2106/00004623-200308000-00009.
  26. Nesse E., Finsen V. Poor results after resection for Haglund’s heel. analysis of 35 heels in 23 patients after 3 years. Acta Orthop Scand. 1994;65(1):107-109.
  27. Pauker M., Katz K., Yosipovitch Z. Calcaneal ostectomy for Haglund disease. J Foot Surg. 1992;31(6):588-589.
  28. Schepsis A.A., Wagner C., Leach R.E. Surgical management of achilles tendon overuse injuries. A long-term follow-up study. Am J Sports Med. 1994;22(5):611-619. doi: 10.1177/036354659402200508.
  29. Schneider W., Niehus W., Knahr K. Haglund’s syndrome: disappointing results following surgery: A clinical and radiographic analysis. Foot Ankle Int. 2000;21(1):26-30. doi: 10.1177/107110070002100105.
  30. Natarajan S., Narayanan V.L. Haglund Deformity - Surgical Resection by the lateral approach. Malays Orthop J. 2015;9(1):1-3. doi: 10.5704/Moj.1503.006.
  31. Jiang Y., Li Y., Tao T., Li W., Zhang K., Gui J., Ma Y. The doublerow suture technique: a better option for the treatment of haglund syndrome. Biomed Res Int. 2016;2016:1895948. doi: 10.1155/2016/1895948.
  32. Ahn J.H., Ahn C.Y., Byun C.H., Kim Y.C. Operative treatment of haglund syndrome with central achilles tendon-splitting approach. J Foot Ankle Surg. 2015;54(6):1053-1056. doi: 10.1053/j.jfas.2015.05.002.
  33. Vega J., Baduell A., Malagelada F., Allmendinger J., Dalmau-Pastor M. Endoscopic achilles tendon augmentation with suture anchors after calcaneal exostectomy in haglund syndrome. Foot Ankle Int. 2018;39(5):551-559. doi: 10.1177/1071100717750888.
  34. Lin C., Ma L., Chen W., Tao X., Yuan C.S., Zhou B.H., Tang K.L. [Acomparative study of the calcaneal closingwedge calcaneal osteotomy versus posterior-superior prominence removal in both sides with Haglund syndrome]. Zhonghua Yi Xue Za Zhi.2017 19;97(35):2733-2736. doi: 10.3760/cma.j.issn.0376-2491.2017.35.004. (In Chinese).
  35. Jardé O., Quenot P., Trinquier-Lautard J.L., Tran-Van F., Vives P. [Haglund disease treated by simple resection of calcaneus tuberosity. an angular and therapeutic study. apropos of 74 cases with 2 years follow-up]. Rev Chir Orthop Reparatrice Appar Mot.1997;83(6):566-573. (In French).
  36. Jerosch J., Schunck J., Sokkar S.H. Endoscopic calcaneoplasty (ecP) as a surgical treatment of Haglund’s syndrome. Knee Surg Sports Traumatol Arthrosc. 2007; 15(7):927-934. doi: 10.1007/s00167-006-0279-3.
  37. Morag G., Maman E., Arbel R. Endoscopic treatment of hind-foot pathology. Arthroscopy. 2003;19(2):e13. doi: 10.1053/jars.2003.50063.
  38. Scholten P.E., Van Dijk C.N. Endoscopic calcaneoplasty. Foot Ankle Clin. 2006;11(2):439-446, viii. doi: 10.1016/j.fcl.2006.02.004.
  39. van Sterkenburg M.N. Achilles tendinopathy: new insights in cause of pain, diagnosis and management [Dissertation]. amsterdam: faculty of Medicine universiteit van amsterdam, 2012. 239 p. ISBN 978-94-6169-210-8.
  40. van Dijk C.N., Van Dyk G.E., Scholten P.E., Kort N.P. Endoscopic calcaneoplasty. Am J Sports Med. 2001;29(2): 185-189. doi: 10.1177/03635465010290021101.
  41. Wu Z., Hua Y., Li Y., Chen S. Endoscopic treatment of Haglund’s syndrome with a three portal technique. Int Orthop. 2012;36(8):1623-1627. doi: 10.1007/s00264-012-1518-5.
  42. Syed T.A., Perera A. Aproposed staging classification for minimally invasive management of haglund’s syndrome with percutaneous and endoscopic surgery. Foot Ankle Clin. 2016;21(3):641-664. doi: 10.1016/j.fcl.2016.04.004.
  43. Zadek I. An operation for the cure of achillobursitis. Am J Surg. 1939;43:542-546.
  44. Hunt K.J., Cohen B.E., Davis W.H., Anderson R.B., Jones C.P. Surgical treatment of insertional achilles tendinopathy with or without flexor hallucis longus tendon transfer: a prospective, randomized study. Foot Ankle Int. 2015;36(9):998-1005. doi: 10.1177/1071100715586182.
  45. Wagner E., Gould J.S., Kneidel M., Fleisig G.S., Fowler R. Technique and results of achilles tendon detachment and reconstruction for insertional achilles tendinosis. Foot Ankle Int. 2006;27(9):677-684.
  46. Fowler A., Philip J.F. Abnormality of the calcaneus as a cause of painful heel its diagnosis and operative treatment. Br J Surg. 1945;32(128):494-498.
  47. Fuglsang F., Torup D. Bursitis retrocalcanearis. Acta Orthop Scand. 1961;30:315-323.
  48. Heneghan M.A., Pavlov H. The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications. Clin Orthop Relat Res. 1984;(187):228-234.
  49. Vega M.R., Cavolo D.J., Green R.M., Cohen R.S. Haglund’s deformity. J Am Podiatry Assoc. 1984;74(3): 129-135. doi: 10.7547/87507315-74-3-129.
  50. Steffensen J.C.A., Evensen A. Bursitis retrocalcanea achilli. Acta Orthop Scand. 1958;27(3):229-236.
  51. Chauveaux D., Liet P., Le Huec J.C., Midy D. A new radiologic measurement for the diagnosis of Haglund’s deformity. Surg Radiol Anat. 1991;13(1):39-44.
  52. Tourné Y., Baray A.L., Barthélémy R., Moroney P. Contribution of a new radiologic calcaneal measurement to the treatment decision tree in Haglund syndrome. Orthop Traumatol Surg Res. 2018;104(8): 1215-1219. doi: 10.1016/j.otsr.2018.08.014.
  53. Dickinson P.H., Coutts M.B., Woodward E.P., Handler D. Tendo achillis bursitis. Report of twenty-one cases. J Bone Joint Surg Am. 1966;48(1):77-81.
  54. Ефименко Н.А., Середа А.П., Зеленский А.А. Антибиотикопрофилактика в хирургии. Инфекции в хирургии. 2007;5(4):14.
  55. Ефименко Н.А., Гицюк А.А., Середа А.П. Антибиотикопрофилактика в травматологии и ортопедии. Инфекции в хирургии. 2008;6(2):9.
  56. Середа А.П., Анисимов Е.А. Инфекционные осложнения после хирургического лечения спортивной травмы ахиллова сухожилия. Медицина экстремальных ситуаций. 2015;(4):90-97.

Statistics

Views

Abstract: 950

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies