gms | German Medical Science

Objectives: Haglund deformity is a common condition causing posterior heel pain, characterized clinically by a painful soft tissue swelling at the level of the Achilles tendon insertion. The central-splitting approach and augmentation of the Achilles tendon using Flexor Hallucis Longus (FHL) tendon transfer has been described as a surgical option for failed conservative treatment. Our study aim was to assess the patient reported outcomes and function following this technique.

Methods: 26 patients (20 female and 6 male) that underwent surgical treatment between January 2013 and January 2019 with a minimum follow-up period of 12 months were reviewed at one surgeons practice. Outcome measures included the Patient Reported Outcome Measurement Information System (PROMIS) score, Visual Analogue Scale (VAS) and the ability to perform multiple single leg heel raises.

Results and Conclusion: All the scores, VAS, PROMIS - Global - 10 Score and the ability to perform a single leg heel raise showed statistically significant improvement (p<0.05) with overall patient satisfaction except for PROMIS Mental Health SE. 90% of the patients were able to perform a single leg heel raise and there was no perceived weakness of hallux flexion. The ability to perform asingle heel raise improved significantly after surgery (p<0.001). All patients were able to return to previous level of function with no major complications. The FHL transfer to augment the Achilles tendon was performed in 16 cases out of 20 (80%). VAS, PROMIS and the ability to perform a single leg heel raise tended to be superior in patients that received the augmentation of the Achilles tendon using the FHL transfer but was not statistically significant

The central-splitting approach, debridement, re-attachment and augmentation of the Achilles tendon using FHL transfer is an effective method with marked improvement in function for patients with Haglund Deformity and Achilles Insertional Tendinopathy.