Abstract
Introduction:
Haglund’s deformity is an abnormal bony enlargement of posterosuperior part of calcaneus at the attachment of achilles tendon which often leads to retrocalcaneal bursitis and insertional achilles tendinopathy (Haglund’s syndrome) causing back heel pain. Arthroscopic calcaneoplasty, synovectomy and PRP injection should be considered as minimally invasive treatment option with speedy recovery.
Case Report:
A 57 years old woman came with pain and lump at posterior site of left ankle more than right ankle since 6 months before that didn’t respond conservatively. Pain was felt with pressure on left ankle with edema. AOFAS Ankle-Hindfoot score was 65%. X-Ray and MRI showed Haglund’s deformity with achilles tendon impingement. The patient was diagnosed with Haglund’s deformity, retrocalcaneal bursitis and achilles tendinopathy. Arthroscopic calcaneoplasty, synovectomy and PRP injection was then conducted. One week after operation, pain decreased and she could do daily activities better with AOFAS Ankle-Hindfoot score increased to 87%. Two weeks after operation, pain was still felt but seldom with AOFAS Ankle-Hindfoot score remain at 87%.
Result and Discussion:
Haglund’s syndrome is mostly idiopathic with several factors suggested. Clinical features are back heel pain, swelling, bump on posterior heel and inflammation signs. Dorsiflexion causes pain of the ankle. Lateral radiographic can show bony prominence at posterosuperior of calcaneus, calcaneal spur and bone formation at achilles tendon insertion. MRI can additionally show synovitis, retrocalcaneal bursitis and achilles tendinopathy. Conservative treatment is often used to treat Haglund’s syndrome, if it doesn’t respond well then surgical treatment is required. Arthroscopic calcaneoplasty with synovectomy has better outcome compared to open surgery. PRP injection can be added to enhance achilles tendinopathy healing. The AOFAS Ankle-Hindfoot score used is a standardized evaluation which combine subjective and objective information from the patient and the physician, in which a healthy ankle scored 100. In this case, the AOFAS Ankle-Hindfoot score increased significantly from 65% pre-operative to 87% post-operative which shows better functional outcome.
Conclusion:
Treatment of Haglund’s deformity, retrocalcaneal bursitis and achilles tendinopathy with arthroscopic calcaneoplasty, synovectomy and PRP injection should be considered to produce good functional outcome based on AOFAS Ankle-Hindfoot score..