Haglund resection versus Haglund non-resection for calcific insertional Achilles tendinopathy with Haglund deformity: a retrospective study

Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity. A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n=16) and Haglund non-resection (non-resection group, n=13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment–Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively. Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38±5.7 vs. 93.15±12.17; P=0.82), VAS (0.5±0.52 vs. 0.61±0.87; P= 0.66) and VISA-A questionnaire (82.56±13.46 vs. 74.92±16.4; P=0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15±2.51 weeks vs. 11.31±4.06 weeks, P=0.02). The Fowler-Philip angle of the resection group decreased from 55.55°±12.34° preoperatively to 44.52°±10.24° at the latest follow-up (P=0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38°±8.41° preoperatively to 46.52°±8.02° at the latest follow-up (P=0.016). The calcaneal pitch angle of the resection group increased from 22.76°±5.37° preoperatively to 25.98°±6. 4° at the latest follow-up (P=0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm±5.37 mm preoperatively to 173.90 mm±8.07 mm at the latest follow-up (P=0.018). Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformity.