Pain and functional outcomes following open surgical treatment of Haglund syndrome using suture anchor-based Achilles repair: a prospective cohort study.

Abstract

Background: Haglund syndrome is a multifactorial condition characterized by posterosuperior calcaneal prominence, retrocalcaneal bursitis, and varying degrees of Achilles tendon involvement. While both open and endoscopic surgical techniques have been described, the optimal approach for cases with associated tendon pathology remains debated.

Purpose: To evaluate pain and functional outcomes following open surgical management of Haglund syndrome using deformity excision, retrocalcaneal bursa excision, and suture anchor-based Achilles tendon repair.

Study design: Analytical observational Prospective cohort study.

Methods: This study included 30 patients treated between 2022 and 2024 with clinically and radiographically diagnosed Haglund syndrome refractory to conservative management. All patients underwent open surgical excision of the Haglund deformity and retrocalcaneal bursa, along with Achilles tendon debridement and repair (tenodesis) using a double-loaded 5 mm titanium suture anchor. Outcomes were assessed using the Visual Analogue Scale (VAS) for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score preoperatively and at 1-year follow-up. Pre- and postoperative outcomes were compared using paired statistical analysis.

Results: The mean VAS pain score improved significantly from 6.63 ± 1.33 preoperatively to 1.40 ± 1.04 at final follow-up (p < 0.001). The mean reduction in VAS pain scores was 5.23 (95% CI 4.66-5.80), demonstrating a large clinical effect (Cohen's d = 3.43). The mean AOFAS score improved from 60.93 ± 13.13 to 83.13 ± 6.98 (p < 0.001). The mean functional improvement was 25.27 points (95% CI 22.22-28.31), also revealing a large effect size (Cohen's d = 3.10).Two patients (6.7%) developed superficial wound complications, which resolved with conservative management. No cases of deep infection, tendon re-rupture, or implant failure were observed.

Conclusion: Open surgical management with suture anchor-based Achilles tendon repair appears to provide significant improvement in pain and function in patients with refractory Haglund syndrome. However, given the absence of a control group and limited objective outcome measures, further comparative studies are required.

Level of evidence: Level II, prospective cohort study.