Achilles tendon: Haglunds deformity, postero-lateral approach and Arthrex Bio-corkscrew
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There are three main varities of pathology effecting the area of the achilles tendon insertion and to which the description of a Haglunds’ deformity is commonly(and loosely) applied.
Most often the pathology is one of degenerative change at achilles the insertion which may be associated intra-tendinous calcification. There may or may not be an element of anatomical prominence of the postero-lateral calcaneus associated. This tends to produce a fairly broad based swelling across the back of the heel. Usually the painful area is located laterally but it can on occasion be postero-medial.
Less commonly the achilles tendon is normal and the issue is an anatomical variation of the postero-lateral corner of the calcaneus causing pressure when in shoe-wear.
These cases should be imaged using cross sectional imaging to determine as far as can be done the location of both bony deformity and tendinopathy. This will assist in deciding upon the surgical approach to be taken. This will also on occasion show evidence of associated retro-calcaneal bursitis which should be intercurrently treated.
The third variation is a calcaneus that is anatomically prominent posteriorly, laterally and also superiorly. This can cause direct impingement upon the deep(anterior) aspect of the Achilles in the retro-calcaneal area.
These variations in pathology can be treated using the same surgical principles and with successful outcome expected in the majority of patients. The key is to identify the exact location and nature of the pathology causing symptoms.
Non-operative treatment is somewhat less successful when adopted here than for problems with the main body of the achilles tendon.
The 5.5mm Arthrex Bio-corkscrew is produced in a variety of materials including titanium, PLLA, PEEK, and biocomposite. The 5.5mm diameter version is ideally suited for this indication. It is used to re-anchor the achilles back to its insertion, this having been detached to debride the underlying calcaneus. In my practice I allow early protected weight-bearing in a post-operative boot after 2 weeks in the majority of cases if using the Arthrex Corkscrew, assuming at least half the insertion or so has not needed to be detached.
Author: Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.
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