Combination of Zadek Osteotomy and Achilles Tendon Re-Attachment in Severe Haglund Deformity: A Case Report

Kevin Kusuman; I Wayan Subawa; Mohamad Dimas Ismail

doi:10.37287/ijghr.v7i2.5679

Kevin Kusuman Prof Dr IGNG Ngoerah General Hospital & Universitas Udayana
I Wayan Subawa Prof Dr IGNG Ngoerah General Hospital & Universitas Udayana
Mohamad Dimas Ismail Prof Dr IGNG Ngoerah General Hospital & Universitas Udayana

DOI: https://doi.org/10.37287/ijghr.v7i2.5679

Keywords: achilles tendon, case report, haglund deformity, zadek osteotomy

Abstract

Haglund deformity refers to a bony exostosis on the posterosuperior aspect of the calcaneus, often causing retrocalcaneal bursitis and Achilles tendinopathy. Conservative treatments, including physiotherapy and medication, may not relieve symptoms in severe cases. Surgical intervention is indicated when non-operative treatments fail. This report highlights a case of severe Haglund deformity managed with Zadek osteotomy and Achilles tendon re-attachment.Case Presentation: A 45-year-old female presented with 2 months of severe right heel pain and a 2-year history of a prominent bump. Physical therapy yielded no improvement. Clinical and radiographic evaluation confirmed Haglund deformity with insertional Achilles tendinopathy. Surgical treatment involved Zadek osteotomy, fixation with screws, and Achilles tendon re-attachment using a suture anchor. The combined approach addressed both the bony deformity and tendon degeneration. Post-operative outcomes showed significant improvement. At the 3-month follow-up, the patients Visual Analog Scale (VAS) pain score decreased from 7/10 to 1/10, and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score improved from 55 to 90. The range of motion was near normal, and functional recovery was excellent. This case demonstrates the effectiveness of combining Zadek osteotomy and Achilles tendon re-attachment for treating severe Haglund deformity. This approach provided significant pain relief and functional recovery, making it a viable option for patients with similar conditions refractory to conservative management.

References

Agostinho, M., Gomes, D. L., Monteiro, G. F., Fernandes, J., & Neto, A. (2020). Percutaneous surgery in the treatment of Haglund syndrome : a systematic review. J Foot Ankle, 14(3), 285–292.

Akoh, C. C., & DeOrio, J. K. (2021). Retrocalcaneal spur removal and achilles tendon reattachment for the treatment of haglund deformity. Techniques in Foot and Ankle Surgery, 20(2), 103–108. https://doi.org/10.1097/BTF.0000000000000279

Anastasio, A. T., Hinton, Z., Danilkowicz, R., & Amendola, A. (2023). Haglund Excision and Suture Bridge Repair. Video Journal of Sports Medicine, 3(2), 263502542211352. https://doi.org/10.1177/26350254221135215

Bakaes, Y., Hall, S. R., Jackson, J. B., Johnson, A. H., Schipper, O. N., Vulcano, E., Kaplan, J. R. M., & Gonzalez, T. A. (2024). Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund’s Deformity: A Systematic Review. Foot and Ankle Orthopaedics, 9(2). https://doi.org/10.1177/24730114241241320

Bohdan, G., Igor, L., Street, B., Oleksandr, M., & Maksym, S. (2020). Insertional Achilles Tendinopathy In Patients With Haglund’s Syndrome: Results Of Computer Modeling and Biomechanical Research. Journal of Education, Health and Sport, 10(7), 396–420.

Choo, Y. J., Park, C. H., & Chang, M. C. (2020). Rearfoot disorders and conservative treatment : a narrative review. Annals of Palliative Medicine, 9(5), 3546–3552. https://doi.org/10.21037/apm-20-446

Doğan, D., & Uçar, N. (2023). Haglund’s Disease with Clinical and Radiological Findings: 3 Case Reports. Medical Science and Discovery, 10(6), 421–425. https://doi.org/10.36472/msd.v10i6.956

Ebben, B. J., Buckley, S. E., Hewitt, M. A., Moon, D. K., Metzl, J. A., & Hunt, K. J. (2022). Outcomes in Open and Endoscopic Treatment for Haglund’s Syndrome and Insertional Achilles Tendinopathy. AOFAS Annual Meeting, 7(4), 2022. https://doi.org/10.1177/2473011421S00652

Fauzi, A. (2022). Haglund Deformity: Diagnosis and Treatment. Cermin Dunia Kedokteran, 49(10), 548–551. https://doi.org/10.55175/cdk.v49i10.303

Hall, S., Kaplan, J. R. M., Phillips, T., Jackson, J. B., Vulcano, E., & Gonzalez, T. A. (2024). The surgical learning curve for percutaneous Zadek osteotomy for treatment of insertional achilles tendinopathy. Archives of Orthopaedic and Trauma Surgery, 1–7.

Mousa, N. M., Sc, M., Youssef, E. F., & Abdelmegeed, M. (2023). Relationship between Pain and Ankle Mobility in Subjects with Haglund Syndrome. Med. J. Cairo Univ, 91(4), 1475–1478.

Nordio, A., Chan, J. J., Guzman, J. Z., Hasija, R., & Vulcano, E. (2019). Foot and Ankle Surgery Percutaneous Zadek osteotomy for the treatment of insertional Achilles tendinopathy. Foot and Ankle Surgery. https://doi.org/10.1016/j.fas.2019.10.011

Patch, D. A., Andrews, N. A., Scheinberg, M., Jacobs, R. A., Harrelson, W. M., Rallapalle, V., Sinha, T., & Shah, A. (2023). Achilles tendon disorders: An overview of diagnosis and conservative treatment. Journal of the American Academy of Physician Assistants, 36(10), 1–8. https://doi.org/10.1097/01.JAA.0000977720.10055.c4

Shaalan, A. A., Shawky, M. S., Halawa, A., & Farag, H. E. (2022). Surgical Methods Of Management Of Haglund Deformity. Benha Journal of Applied Sciences, 2022(7), 1–6.

So, J. M., Roukis, T. S., Mauk, K. T., Anderson, J. S., Musselman, T. M., & Piraino, J. A. (2024). Complications following surgical management of Haglund’s triad: A retrospective, single-center analysis. Foot & Ankle Surgery: Techniques, Reports & Cases, 4(1), 100345. https://doi.org/10.1016/j.fastrc.2023.100345

Strasser, N. L., & Farina, K. A. (2021). Haglund’s Syndrome and Insertional Achilles Tendinopathy. Operative Techniques in Sports Medicine, 29(3), 150850. https://doi.org/10.1016/j.otsm.2021.150850

Sung, K., Bahadur, A. S., & Sussman, W. I. (2023). A Novel Approach to Haglund Deformity Resection Using a Percutaneous Ultrasound-Guided Osteotomy Device. Current Sports Medicine Reports, 22(5), 168–171. https://doi.org/10.1249/JSR.0000000000001063

Tang, S., Tu, K., Liao, W., Hsu, C., Shih, H., Tung, K., Wu, M., & Wang, S. (2022). Novel Radiographic Measurements for Operatively Treated Haglund ’ s Deformity. Tomography, 8, 284–292.

Tourne, Y., Baray, A. L., Barthelemy, R., Karhao, T., & Moroney, P. (2022). The Zadek calcaneal osteotomy in Haglund’s syndrome of the heel: Clinical results and a radiographic analysis to explain its efficacy. Foot and Ankle Surgery, 28(1), 79–87. https://doi.org/10.1016/j.fas.2021.02.001

Usman, M. A., Murtaza, B., Acarya, P., Winangun, N., & Kennedy, D. (2022). Chronic Rupture of Achilles Tendon Caused by Haglund ’ s Deformity : A Case Report. Medicina, 58(1216), 1–7.

Xu, Y., Haider, Z. A., Karuppiah, V., & Dhar, S. (2023). Zadek Osteotomy , a Good Treatment Option for Refractory Haglund ’ s Deformity. Cureus, 15(5). https://doi.org/10.7759/cureus.39497

Yuen, W. L. P., Tan, P. T., & Kon, K. K. C. (2022). Surgical Treatment of Haglund’s Deformity: A Systematic Review and Meta-Analysis. Cureus, 14(7). https://doi.org/10.7759/cureus.27500

Zheng, W., Du, J., Liang, J., Zhang, Y., Liang, X., & Zhao, H. (2020). Zadek osteotomy for the treatment of Haglund’s Syndrome. 1–9. https://doi.org/10.21203/rs.3.rs-37115/v1

Zhou, S., Li, W., Xiang, H., & Zhang, K. (2023). Haglund’s syndrome: a case description. Quantitative Imaging in Medicine and Surgery, 13(2), 1227–1231. https://doi.org/10.21037/qims-22-736

Zifa, Z. F., Oussama, E. A., Omar, F., Reda, H. A., & Mustapha, F. (2023). Reinsertion of the Achilles Tendon with Bony Anchor in Insertional Achilles Tendinitis with Haglund ’ s Deformity. Advances in Surgical Sciences, 11(1), 10–13. https://doi.org/10.11648/j.ass.20231101.11.