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Cardone G, Bilbao F, Verbner JM, Cafruni VM, Carrasco MN. Endoscopic Calcaneoplasty in Haglund Disease: Surgical Technique, Clinical and Subjective Outcomes. Foot Ankle Int 2024:10711007241264223. [PMID: 39095985 DOI: 10.1177/10711007241264223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND During the last decade, arthroscopic procedures have been replacing open techniques in Haglund disease treatment because of their considerable advantages. Endoscopic calcaneoplasty is a technique that allows resection of posterosuperior calcaneal exostosis and retrocalcaneal bursitis. The objective of this article was to describe this technique and report its clinical and subjective outcome. METHODS A retrospective study was performed of consecutive patients undergoing endoscopic Haglund resection surgery between July 2014 and March 2020 at a single academic institution. All patients were surveyed in person about the level of pain (visual analog scale), its location (central, lateral, medial or diffuse), its relation with rest, or physical activity. Clinical evaluation was assessed using the hindfoot scale designed by the American Orthopedics Foot & Ankle Society AOFAS. RESULTS In this study, 14 endoscopic calcaneoplasties were performed in 14 patients, with an average follow-up of 40 months. The visual analog scale score improved from a preoperative average value of 9.07 to 1.8 after surgery (P > .0001). The AOFAS scale rose from 38.7 before surgery to 94.6 postoperative (P > .0001). Good subjective results were observed in 12 patients (85.7%), and all of them would have surgery again. There were no wound complications or infections. No patient required reoperation. CONCLUSION In this relatively small cohort, we found that endoscopic calcaneoplasty was associated with good clinical and subjective results with few complications.
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Affiliation(s)
- Guillermo Cardone
- Hospital Italiano de Buenos Aires, Foot and Ankle Section, Orthopaedics Department, Buenos Aires, Argentina
| | - Facundo Bilbao
- Hospital Italiano de Buenos Aires, Foot and Ankle Section, Orthopaedics Department, Buenos Aires, Argentina
| | - Jonathan M Verbner
- Hospital Italiano de Buenos Aires, Foot and Ankle Section, Orthopaedics Department, Buenos Aires, Argentina
| | - Virginia M Cafruni
- Hospital Italiano de Buenos Aires, Foot and Ankle Section, Orthopaedics Department, Buenos Aires, Argentina
| | - Marina N Carrasco
- Hospital Italiano de Buenos Aires, Foot and Ankle Section, Orthopaedics Department, Buenos Aires, Argentina
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Hall S, Kaplan JRM, Schipper ON, Vulcano E, Johnson AH, Jackson JB, Aiyer AA, Gonzalez TA. Minimally Invasive Approaches to Haglund's Deformity and Insertional Achilles Tendinopathy: A Contemporary Review. Foot Ankle Int 2024; 45:664-675. [PMID: 38647216 PMCID: PMC11165941 DOI: 10.1177/10711007241237529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- SarahRose Hall
- University of South Carolina, School of Medicine, Columbia, SC, USA
| | | | | | - Ettore Vulcano
- Department of Orthopaedic Surgery, Columbia University Mount Sinai Medical Center, Miami Beach, FL, USA
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Ehredt DJ, Razzante MC, Darji D, Miggantz SH. Endoscopic calcaneoplasty with gastrocnemius recession for Haglund's syndrome: Is it safe and effective? Results from a retrospective case series. Foot (Edinb) 2023; 57:101960. [PMID: 37898054 DOI: 10.1016/j.foot.2023.101960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Endoscopic calcaneoplasty (ECP) and gastrocnemius recession (GR) are procedures that have been described to effectively treat Haglund's deformity and insertional Achilles tendinopathy respectively. The purpose of our manuscript is to evaluate the efficacy and safety of ECP and GR with immediate weightbearing for the treatment of Haglund's deformity with mild to moderate insertional Achilles tendinopathy. METHODS We performed ECP coupled with GR on 14 patients with an average age of 52 years. All patients demonstrated < 50% tendinous degeneration on MRI. All were allowed weightbearing as tolerated in a CAM boot within the first post-operative week. AOFAS scores and plain film radiographic findings were collected pre-operatively and post-operatively. RESULTS The radiographic exam of the Fowler-Philip angle significantly improved from an average 60.1-40.7° (p < 0.001). The AOFAS ankle/hindfoot score significantly improved from an average 54.7-91.4 (p < 0.001). The average return to work was 7.5 weeks. There were two cases of temporary sural nerve paresthesia, and two cases of delayed wound healing. CONCLUSIONS This is the first mid-term study evaluating the outcomes of ECP with GR. The results of our study suggest that ECP with GR followed by immediate weightbearing is a safe and effective procedure for the treatment of Haglund's deformity and mild to moderate insertional Achilles tendinopathy.
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Affiliation(s)
- Duane J Ehredt
- Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH, USA.
| | - Mark C Razzante
- California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA, USA
| | - Deepali Darji
- Podiatric Medicine and Surgery Resident, Saint Vincent Charity Medical Center, Cleveland, OH, USA
| | - Sydney H Miggantz
- Podiatric Medical Student, Kent State University College of Podiatric Medicine, Independence, OH, USA
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Sung K, Bahadur AS, Sussman WI. A Novel Approach to Haglund Deformity Resection Using a Percutaneous Ultrasound-Guided Osteotomy Device. Curr Sports Med Rep 2023; 22:168-171. [PMID: 37141611 DOI: 10.1249/jsr.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Kyungje Sung
- Department of Orthopedics and Rehabilitation, Tufts University, Boston, MA
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Nakajima K. Fluoroscopic and Endoscopic Calcaneal Exostosis Resection and Achilles Tendon Debridement for Insertional Achilles Tendinopathy Results in Good Outcomes, Early Return to Sports Activities, and Few Wound Complications. Arthrosc Sports Med Rehabil 2022; 4:e1385-e1395. [PMID: 36033171 PMCID: PMC9402468 DOI: 10.1016/j.asmr.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/24/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To review the outcomes of patients with insertional Achilles tendinopathy who underwent a minimally invasive surgery: fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement. Methods The medical records of consecutive patients who underwent this surgery from February 2017 to July 2019 were reviewed. The inclusion criterion was ≥2-year follow-up. The exclusion criterion was another surgery performed on the ipsilateral or contralateral foot. Haglund deformity resection was not combined with this surgery. The outcomes were assessed using the visual analog scale (VAS) score and the Japanese Society for Surgery of the Foot (JSSF) scores for all patients and the Victorian Institute of Sport Assessment self-administered Achilles (VISA-A) scores for patients participating in sports activities. The Wilcoxon signed-rank test and the thresholds of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were used for statistical analyses. Results Forty-four patients with a mean age of 55.7 ± 11.0 years and mean body mass index of 26.0 ± 4.0 kg/m2 were included. The mean follow-up duration was 2.8 ± 0.7 years. Of all participants, 22 participated in sports activities. The overall median VAS and JSSF scores improved from 64.5 to 6.5 mm and from 67.0 to 100 points, respectively (P < .001). The percentages of patients who achieved the MCID for the VAS, JSSF, and VISA-A scores were 100%, 93.2%, and 100%, respectively, and the percentages of patients who achieved the PASS for the VAS, JSSF, and VISA-A scores were 77.3%, 86.4%, and 81.8%, respectively. The median VISA-A scores improved from 40.5 to 95.0 points (P < .001). The median time to return to sport was 4.5 months. Complications included five cases of reoperation and two cases of scar sensitivity. Conclusion For patients with insertional Achilles tendinopathy, fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement resulted in good outcomes, early return to sports activities, and few wound complications. Level of Evidence IV, therapeutic case series
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Qin B, Wu S, Zhang H. Evaluation and Management of Cavus Foot in Adults: A Narrative Review. J Clin Med 2022; 11:jcm11133679. [PMID: 35806964 PMCID: PMC9267353 DOI: 10.3390/jcm11133679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Cavus foot is a deformity defined by the abnormal elevation of the medial arch of the foot and is a common but challenging occurrence for foot and ankle surgeons. In this review, we mainly aim to provide a comprehensive evaluation of the treatment options available for cavus foot correction based on the current research and our experience and to highlight new technologies and future research directions. Methods: Searches on the PubMed and Scopus databases were conducted using the search terms cavus foot, CMT (Charcot–Marie–Tooth), tendon-transfer, osteotomy, and adult. The studies were screened according to the inclusion and exclusion criteria, and the correction of cavus foot was analyzed based on the current research and our own experience. At the same time, 3D models were used to simulate different surgical methods for cavus foot correction. Results: A total of 575 papers were identified and subsequently evaluated based on the title, abstract, and full text. A total of 84 articles were finally included in the review. The deformities involved in cavus foot are complex. Neuromuscular disorders are the main etiologies of cavus foot. Clinical evaluations including biomechanics, etiology, classification, pathophysiology and physical and radiological examinations should be conducted carefully in order to acquire a full understanding of cavus deformities. Soft-tissue release, tendon-transfer, and bony reconstruction are commonly used to correct cavus foot. Surgical plans need to be customized for different patients and usually involve a combination of multiple surgical procedures. A 3D simulation is helpful in that it allows us to gain a more intuitive understanding of various osteotomy methods. Conclusion: The treatment of cavus foot requires us to make personalized operation plans according to different patients based on the comprehensive evaluation of their deformities. A combination of soft-tissue and bony procedures is required. Bony procedures are indispensable for cavus correction. With the promotion of digital orthopedics around the world, we can use computer technology to design and implement cavus foot operations in the future.
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Management of Insertional Achilles Tendinopathy. J Am Acad Orthop Surg 2022; 30:e751-e759. [PMID: 35286285 DOI: 10.5435/jaaos-d-21-00679] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/29/2022] [Indexed: 02/01/2023] Open
Abstract
Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.
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Miller CP, McWilliam JR, Michalski MP, Acevedo J. Endoscopic Haglund's Resection and Percutaneous Double-Row Insertional Achilles Repair. Foot Ankle Spec 2021; 14:534-543. [PMID: 33840259 DOI: 10.1177/19386400211002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Insertional Achilles tendinopathy can be a debilitating condition that often fails to improve with nonsurgical management such as bracing and physical therapy. Traditional surgical techniques include an open debridement of the diseased tendon and resection of calcaneal spurs. This is followed by repair of the tendon. Suture anchors are often used to secure the tendon, but recent advances in tendon fixation, including the advent of double-row repairs, has allowed better biomechanical repairs and faster rehabilitation. Additionally, minimally invasive surgery and endoscopic techniques have advanced to allow successful treatment of all aspects of the condition while minimizing wound complications and infection. The authors present a technique to treat insertional Achilles tendinopathy and calcaneal bone spurs using minimally invasive surgery techniques while also incorporating a percutaneous double-row suture anchor repair. The technique utilizes 4 portals to access 2 endoscopic working planes. The burr is inserted deep to the tendon and the calcaneoplasty is performed. Subsequently, the endoscope is inserted alongside a shaver to remove bony debris and debulk the anterior aspect of the Achilles areas of tendinopathy. Following this, the portals are used to place a double-row suture anchor repair.Levels of Evidence: Level V.
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Affiliation(s)
- Christopher P Miller
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - James R McWilliam
- New York Medical College, Valhalla, New York.,White Plains Hospital Physicians Associates, White Plains, New York
| | - Max P Michalski
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jorge Acevedo
- Department of Orthopedics, Southeast Orthopedic Specialists, Jacksonville, Florida
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Construct Validity and Responsiveness of the University of Wisconsin Running Injury and Recovery Index. J Orthop Sports Phys Ther 2020; 50:702-710. [PMID: 33115339 DOI: 10.2519/jospt.2020.9698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The University of Wisconsin Running Injury and Recovery Index (UWRI) is the first running-specific patient-reported outcome measure (PROM). The UWRI evaluates the key elements runners use to self-assess running ability during recovery. This study evaluated the construct-related validity and responsiveness of the UWRI as an evaluative PROM of running ability following running-related injury (RRI). DESIGN Prospective longitudinal study. METHODS Runners seeking care from a physical therapist for an RRI (n = 396) completed PROMs at baseline and 12 weeks later. Change in UWRI score was validated against the global rating of change (GROC), Veterans RAND 12-Item Health Survey (VR-12) change, and change in body region- specific PROMs. Responsiveness was evaluated using anchor-based and distribution-based techniques. RESULTS Change in UWRI score (mean ± SD, 7.7 ± 8.9 points) was correlated with the GROC (r = 0.67), as well as with changes in the VR-12 Physical Component Summary (PCS) (r = 0.54) and Mental Component Summary (MCS) (r = 0.31). Change in UWRI score was correlated with changes in the Foot and Ankle Ability Measure sports subscale (r = 0.75), the 12-item International Hip Outcome Tool (r = 0.75), and the Anterior Knee Pain Scale (r = 0.48), but not with the Oswestry Disability Index Version 2.0 (r = 0.05). Change in UWRI score was significantly different in runners reporting significant improvement (12.2 ± 5.9 points), slight improvement (7.1 ± 6.6 points), no change (0.0 ± 9.1 points), and worsening (-14.6 ± 7.4 points) on the GROC anchor-based responsiveness assessment. The UWRI minimal important change and minimal clinically important difference were 5 and 8 points, respectively. CONCLUSION The UWRI is a valid clinical tool for evaluating running ability following RRI; it demonstrated longitudinal validity (GROC), convergent validity (PCS and body region- specific PROMs), divergent validity (MCS), and responsiveness to changes in patient-perceived running ability. J Orthop Sports Phys Ther 2020;50(12):702-710. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9698.
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Del Vecchio JJ, Dealbera ED, Ghioldi ME, Chemes LN. Letter Regarding: Biomechanical Comparison of Achilles Tendon Pullout Strength Following Midline Tendon-Splitting and Endoscopic Approaches for Calcaneoplasty. Foot Ankle Int 2020; 41:885-886. [PMID: 32628891 DOI: 10.1177/1071100720929346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Michalski MP, Gonzalez TA, Metzger MF, Nelson TJ, Eberlein S, Pfeffer GB. Response to "Letter Regarding: Biomechanical Comparison of Achilles Tendon Pullout Strength Following Midline Tendon-Splitting and Endoscopic Approaches for Calcaneoplasty". Foot Ankle Int 2020; 41:887-888. [PMID: 32628892 DOI: 10.1177/1071100720929345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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