Descriptive Epidemiology of Haglund’s Syndrome: A Large Retrospective Cohort Study
Authors: Kutzer Katherine , Morrissette Kali , Wu Kevin , Krez Alexandra , Hinton Zoe , Anastasio Albert T. , Reinke Emily , Amendola Annunziato 
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

Approximately 6% of individuals will experience Achilles tendon pain during their lifetime, with one-third of these patients having Haglund’s syndrome. The condition represents a triad of posterosuperior calcaneal bony enlargement (Haglund’s deformity), retrocalcaneal bursitis, and Achilles tendinopathy and may be bilateral or unilateral. If a prolonged course of conservative treatment fails, surgical options include utilizing a suture bridge (SB), corkscrew anchors (CS), or suture anchors (SA). The goal of this study is to investigate outcomes comparing various surgical techniques and postoperative weightbearing status.

Methods:

After institutional approval, retrospective data were collected from 476 patients who received surgical treatment for Haglund’s syndrome across 8 surgeons at an academic institution from January 2015 to July 2022. Demographic data and surgical repair technique data (suture bridge – SB, corkscrew – CS, suture anchors – SA) were collected. Additional data included weightbearing status (weightbearing as tolerated -WBAT, non-weightbearing – NWB, partial weightbearing – PWB, touch down weightbearing – TDWB), complications, revisions, and date of patients’ last follow-up. Post-operative complications included Achilles rupture, wound breakdown/infection, deep venous thrombosis, plantarflexion weakness, or other complications. Descriptive statistics were completed.

Results:

Across 390 patients, the cohort averaged 55.14 years old and was 66.4% female. The most common racial groups were Caucasian (72.8%), African American (20.8%), and Asian (1.3%). Average BMI was 34.83 (σ =7.00) and 17.4% had diabetes. Smoking status was reported as 267 (68.5%) never, 120 (30%) current or former. ASA III was the most common scoring with n=186 (47.7%). Repair type was divided among SB (58%), SA (20.8%), and CS (21.3%). Time to last follow-up had a median of 5.8 months, range [0 days-7 years]. Postoperative recommendations also varied from NWB (68.7%), TDWB (14.4%), WBAT (13.8%), and PWB (2.3%). Overall, 75 (19.2%) patients experienced a complication, including 40 (10.3%) persistent pain, 32 (8.2%) wound breakdowns, and 1 (10.3%) rupture, with 7 (1.8%) requiring revision.

Conclusion:

This study offers the largest single-institution series for the operative management of Haglund’s syndrome with long-term follow-up. Certain patient characteristics (increased age, Black or African American race, female sex, and diabetes) were greater in this cohort compared to national averages. The postoperative complication rate was 20% (n=78), with WBAT reporting the highest rate of pain (14.8%) and PWB reporting the lowest (0.0%). Wound breakdown was highest for NWB (9.7%), and one rupture occurred in the WBAT group. Future research should utilize multicenter institutional data with large sample sizes to analyze associations between patient characteristics, surgical technique, and complication rates.