Painful Haglund's deformity that fails to improve with 6 months of non-operative treatment.
Open wound / Blister
Periperal Vascular disease
Pre-op Planning / Special Considerations
Lateral and or medial incisions may be used. Single lateral incisions decrease risk of injury to medial calcaneal sensory nerve and wound problems.
As much as 50% of the insertion of the Achilles tendon can be safely resected. (Kolodziej P, Foot Ankle Int 1999;20:433).
Pre-operative antibiotics, +/- regional block
General endotracheal anesthesia
Prone position with bulster under leg. All bony prominences well padded.
Prep and drape in standard sterile fashion.
8cm-longitudinal incision just anterior to the lateral aspect of the Achilles tendon.
Expose retrocalcaneal bursa and posterior-superior calcaneous.
Perfom oblique osteotomy with oscillating saw from the superior angle of the calcaneous @1.5cm anterior to the posterior border of the calcaneous and angling downward to the Achilles insertion @2cm distal to the superior margin of the calcaneous.
Ensure to ridge of bone is left that will irritate the Achilles. Consider using microreciprocating rasp.
Palpate the area of prior prominence throught the overlying skin ensuring all prominences are removed.
Longitudinal incision in the anterior 50% of the Achilles is made and the tendon is inspected for necrotic areas and debrided as indicated.
Repair Achilles tendon with buried 3-0 non-absorable suture (Ethibond).
Close in layers.
Place in bulky-Jones splint in mild equines. Non-weight bearing
Achilles tendon laceration or avulsion
Persistent posterior heel pain
Medial calcaneal sensory nerve injury
Sural nerve injury
At 1-2 week follow-up: short-leg walking cast in neutral vs mild equines depending on status of Achilles tendon at surgery.
At 4 weeks: 1/2 inch heel lift, weight-bearing as tolerated with activity limitations
At 3 months: resume normal activities.
Full recovery is typically prolonged and takes 6-12 months.
(Sammarco GJ, Foot Ankle Int 1998;19:724).
(Schneider W, Foot Ankle Int 2000;21:26).
Frey C, in Masters Technique Foot and Ankle, 2nd ed, 2002