Weightbearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Large Retrospective Analysis.

Abstract

Background: Following insertional Achilles tendinopathy debridement and Haglund prominence resection for Haglund syndrome, patients undergo varying degrees of weightbearing limitation (weightbearing as tolerated [WBAT], partial weightbearing [PWB], touchdown weightbearing [TDWB], and nonweightbearing [NWB]). Given the scarcity of large-scale literature on the topic, the purpose of this study is to evaluate the impact of postoperative weightbearing protocols on outcomes after open surgical management of Haglund syndrome.

Methods: This was a retrospective cohort study of patients who underwent open surgical management for Haglund syndrome between January 2015 and December 2023 at a single academic institution by fellowship-trained foot and ankle surgeons. Patients were excluded if they underwent concurrent operative management of additional foot pathologies. Patient demographics, comorbidities, surgical techniques, and postoperative weightbearing protocols were recorded. Complications (Achilles tendon rupture, wound breakdown/infection, persistent pain, plantarflexion weakness) and revision rates were compared across weightbearing protocols. Statistical analysis was conducted using R with significance set at P <.05.

Results: Three-hundred eighty-seven patients were included (mean age 55.2 years, 66.1% female) with a mean follow-up of 10.1 (range: 0-86.3) months. The most common regimen was NWB (n = 268; 69.3%) followed by TDWB (n = 56; 14.5%), WBAT (n = 54; 14.0%), and PWB (n = 9; 2.3%). There were no significant differences in complications between the weightbearing protocols (P = .48354). Complications included persistent pain (n = 40; 10.3%), weakness (n = 6; 1.6%), wound breakdown/infection (n = 33; 8.5%), and rupture (n = 1; 0.3%)]. Revision surgery occurred in 1.8% (n = 7).

Conclusion: This large cohort study found no significant association between postoperative weightbearing protocols and outcomes following open surgical treatment for Haglund syndrome at a mean follow-up of 10.1 months. This study provides evidence that surgeons can individualize appropriate weightbearing protocols based on patient needs and preferences when treating Haglund syndrome with Achilles debridement and Haglund resection.

Level of evidence: Level III, comparative study.