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Haglund’s syndrome: classification system and surgical protocol

Diab, Hossam S. MD

doi: 10.1097/BCO.0000000000000429

Background: Haglund’s deformity is not an uncommon cause of retrocalcaneal pain. Currently, there is neither a classification system nor a standard surgical protocol for this condition. The purpose of this study was to evaluate the outcome after Achilles tendon debridement, partial detachment, and anchor reattachment of the tendon, osteotomy of the Haglund deformity, and excision of the retrocalcaneal bursa. An MRI-based classification system is proposed that relies on the extent of Achilles tendon pathology in the presence of the Haglund deformity.

Methods: Fifty heels in 46 patients were surgically treated with the proposed surgical protocol. Patients were evaluated using the Tegner Activity Level and the Foot and Ankle Outcome (FAOS) scores.

Results: The mean Tegner Activity Level score improved from a preoperative mean of 3.44 to a mean of 6.56 at 6 mo, then to a mean of 6.84 at 12 mo follow-up. The mean FAOS score improved from 47.60 preoperatively to a mean of 66.50 at 6 mo and to a mean of 79.49 at 12 mo follow-up.

Conclusions: Surgical treatment of Haglund’s deformity with tendon debridement, partial detachment, calcaneal osteotomy, and bursal debridement provides good results and functional outcomes that continues to improve over 12 mo follow-up.

Ain Shams University, Cairo, Egypt

Financial Disclosure: The author reports no conflicts of interest.

Correspondence to Hossam S. Diab, MD, Orthopedic Surgery, Ain Shams University, Cairo, Egypt Tel: +00966560041281 (ext. 4142); fax: +009660126695541; e-mail:

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