Surgical Treatment of Retro-calcaneal Bursitis (Haglund’s Disease): Anatomy, Evaluation, Surgical Options, Complications, and Outcome

Vol 32| Issue 2 | July – Dec 2019 | page: 06-13 | Raju Karuppal, Anwar Marthya


Authors: Raju Karuppal [1], Anwar Marthya [2]

[1] Department Of Orthopaedics, Govt. Medical College, Kozhikode, Kerala, India.
[2] Department Of Orthopaedics, IQRAA International Hospital Calicut, Kerala, India.

Address of Correspondence

Dr. Raju Karuppal,
Govt. Medical College, Kozhikode, Kerala, India.
E-mail: drrajuortho@rediffmail.com


Abstract

Retrocalcaneal bursitis (RCB) is one of the common causes of heel pain. Symptoms will often respond well to conventional methods of treatment. Those patients who do not respond to conventional treatment may get benefit from surgical interventions. An awareness of appropriate diagnostic and evaluation techniques are is necessary to diagnose and plan the surgical treatment. Initial treatments of Haglund’s disease include non-steroidal anti-inflammatory drugs, footwear modification, and various physiotherapeutic modalities. Bony hump excision is the main surgical treatment option, which can be performed by various surgical approaches, such as open procedures or by endoscopic techniques. Factors such as local skin condition, and medical co-morbidities which may retard tissue healing, possibilities of Achilles tendon damage, and post-operative pain must be considered while selecting the best surgical option. This article examines patient evaluation, surgical options, complications, and outcome of Haglund’s disease.
Keywords: Retrocalcaneal bursitis, Haglund’s disease, Calcaneal osteotomy, Endoscopic surgery, Complications.


References

1. Maffulli N, Saxena A, Wagner E, Torre G. Achilles insertional tendinopathy: State of the art. J ISAKOS 2018;???:1-10.
2. Sharma SC, Singh R, Piplani H, Sharma A. Radiological evaluation and role of surgery in retrocalcaneal bursitis. Hong Kong J Orthop Surg 2005;9:8-15.
3. White CS. Retrocalcaneal bursitis. N Y Med J 1983;98:263.
4. Haglund P. Beitragzurklinik der Achilles sehne. Z OrthopChir 1928;49:49-58.
5. Schepsis AA, Wagner C, Leach RE. Surgical management of Achilles tendon overuse injuries. A long-term follow-up study.Am J Sports Med1994;22:611-9.
6. McGarvey WC, Palumbo RC, Baxter DE, Leibman BD. Insertional Achilles tendinosis: Surgical treatment through a central tendon splitting approach.Foot Ankle Int2002;23:19-25.
7. TaylorGJ. Prominence of the calcaneus: Is operation justified?J Bone Joint Surg Br1986;68:467-70.
8. AndersonJA, SueroE, O’LoughlinPF, KennedyJG. Surgery for retrocalcaneal bursitis: A tendon-splitting versus a lateral approach.ClinOrthopRelat Res2008;466:1678-82.
9. 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.ActaOrthopBelg2005;71:718-23.
10. Leitze Z, Sella EJ, Aversa JM. Endoscopic decompression of the retrocalcaneal space.J Bone Joint Surg Am2003;85:1488-96.
11. Takao M. Posterior Ankle and Hindfoot Arthroscopy. In: Dragoo J, editor. Modern Arthroscopy. Croatia: InTech; 2011. p. 287-303.
12. Wiegerinck JI, Kok AC, van Dijk CN. Surgical treatment of chronic retrocalcaneal bursitis.Arthroscopy2012;28:283-93.
13. ScholtenPE, vanDijk CN. Endoscopic calcaneoplasty.Foot Ankle Clin2006;11:439-46, 8.
14. PerlmanMD. Enlargement of the entire posterior aspect of the calcaneus: Treatment with the Keck and Kelly calcaneal osteotomy.J Foot Surg1992;31:424-33.
15. vanDijk CN, ScholtenPE, KripsR. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.Arthroscopy2000;16:871-6.
16. vanDijk CN, van Dyk GE, Scholten PE, Kort NP. Endoscopic calcaneoplasty. Am J Sports Med 2001;29:185-9.
17. ApaydinN, BozkurtM, LoukasM, VefaliH, TubbsRS, EsmerAF. Relationships of the sural nerve with the calcaneal tendon: An anatomical study with surgical and clinical implications.Surg RadiolAnat2009;31:775-80.
18. KachlikD, BacaV, CepelikM, HajekP, MandysV, MusilV, et al. Clinical anatomy of the retrocalcaneal bursa.Surg RadiolAnat2008;30:347-53.
19. Williams PL, Warwick R, editors. Gray’s Anatomy. 36thed. New York: Churchill Livingstone; 1980. p. 608.
20. Astrom M. On the Nature and Etiology of Chronic Achilles Tendinopathy, PhD Thesis. Sweden: Lund University; 1997.
21. Christman RA. Radiographic anatomy of the foot and ankle-part 2: The greater tarsus. J Am Podiatr Med Assoc 2014;104:493-503.
22. CanosoJJ, LiuN, TraillMR, RungeVM. Physiology of the retrocalcaneal bursa.Ann Rheum Dis1988;47:910-2.
23. MovinT, Kristoffersen-WibergM, ShalabiA, GadA, AspelinP, RolfC. Intratendinous alterations as imaged by ultrasound and contrast medium-enhanced magnetic resonance in chronic achillodynia.Foot Ankle Int1998;19:311-7.
24. SomaCA, MandelbaumBR. Achilles tendon disorders.Clin Sports Med1994;13:811-23.
25. RuchJA. Haglund’s disease.J Am Podiatry Assoc1974;64:1000-3.
26. BerkebileDE. Chronic Achilles tendonitis.S D J Med1991;44:311-2.
27. StephensMM. Haglund’s deformity and retrocalcaneal bursitis.OrthopClin North Am1994;25:41-6.
28. PavlovH, HeneghanMA, HershA, GoldmanAB, VigoritaV. The Haglund syndrome: Initial and differential diagnosis.Radiology1982;144:83-8.
29. FowlerA, PhillipJF. Abnormaliry of the calcaneus as a cause of painful heef its diagnosis and operative treatment.Brit J Surg1941;32:494-8.
30. ChristmanRA. Radiographic anatomy of the calcaneus. Part II: Posterior surface.J Am Podiatr Med Assoc1987;77:581-5.
31. GrossmanAB, CohenR, HernandezA. Modified calcaneal axial view.J Am Podiatr Med Assoc1993;83:295.
32. FreyC, RosenbergZ, ShereffMJ, KimH. The retrocalcaneal bursa: Anatomy and bursography.Foot Ankle1992;13:203-7.
33. OlivieriI, BarozziL, PadulaA, DeMatteis M, PierroA, CantiniF, et al. Retrocalcaneal bursitis in spondyloarthropathy: Assessment by ultrasonography and magnetic resonance imaging.J Rheumatol1998;25:1352-7.
34. SofkaCM, AdlerRS, PositanoR, PavlovH, LuchsJS. Haglund’s syndrome: Diagnosis and treatment using sonography.HSS J2006;2:27-9.
35. RichardsPJ, BraidJC, CarmontMR, MaffulliN. Achilles tendon ossification: Pathology, imaging and aetiology.DisabilRehabil2008;30:1651-65.
36. ThomasJL, ChristensenJC, KravitzSR, MendicinoRW, SchuberthJM, VanoreJV, et al. The diagnosis and treatment of heel pain: A clinical practice guideline-revision 2010.J Foot Ankle Surg2010;49:S1-19.
37. FuriaJP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy.Am J Sports Med2006;34:733-40.
38. SellaEJ, CaminearDS, McLarneyEA. Haglund’s syndrome.J Foot Ankle Surg1998;37:110-4.
39. WatsonAD, AndersonRB, DavisWH. Comparison of results of retrocalcaneal decompression for retrocalcaneal bursitis and insertional Achilles tendinosis with calcific spur.Foot Ankle Int2000;21:638-42.
40. KolodziejP, GlissonRR, NunleyJA. Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund’s deformity: A biomechanical study.Foot Ankle Int1999;20:433-7.
41. PhisitkulP. Endoscopic surgery of the Achilles tendon.Curr Rev Musculoskelet Med2012;5:156-63.
42. ReinherzRP, SmithBA, HenningKE. Understanding the pathologic Haglund’s deformity.J Foot Surg1990;29:432-5.
43. MaquirriainJ. Endoscopic Achilles tenodesis: A surgical alternative for chronic insertional tendinopathy.Knee Surg Sports TraumatolArthrosc2007;15:940-3.
44. SammarcoGJ, TaylorAL. Operative management of Haglund’s deformity in the nonathlete: A retrospective study.Foot Ankle Int1998;19:724-9.
45. LohrerH, ArentzS. Impingement lesion of the distal anterior Achilles tendon in sub-Achilles bursitis and Haglund-pseudoexostosis-a therapeutic challenge.SportverletzSportschaden2003;17:181-8.
46. RothKE, MuellerR, SchwandE, MaierGS, SchmidtmannI, SariyarM, et al. Open versus endoscopic bone resection of the dorsolateral calcaneal edge: A cadaveric analysis comparing three dimensional CT scans.J Foot Ankle Res2014;7:56.
47. KondreddiV, GopalRK, YalamanchiliRK. Outcome of endoscopic decompression of retrocalcaneal bursitis.Indian J Orthop2012;46:659-63.
48. WuZ, HuaY, LiY, ChenS. Endoscopic treatment of Haglund’s syndrome with a three portal technique.Int Orthop2012;36:1623-7.
49. KeckSW, KellyPJ. Bursitis of the posterior part of the heel; evaluation of surgical treatment of eighteen patients.J Bone Joint Surg Am1965;47:267-73.
50. AngermannP. Chronic retrocalcaneal bursitis treated by resection of the calcaneus.Foot Ankle1990;10:285-7.


How to Cite this Article: Karuppal R, Marthya | A Surgical Treatment of Retro-calcaneal Bursitis (Haglund’s Disease): Anatomy, Evaluation, Surgical Options, Complications, and Outcome | Kerala Journal of Orthopaedics | July – Dec 2019 ; 32(2): 06-13 .

(Abstract)      (Full Text HTML)   (Download PDF)


 

 

 

 

 

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *