Weightbearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Large Retrospective Analysis.
Date
2025-01
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Abstract
Background
Following insertional Achilles tendinopathy debridement and Haglund prominence resection for Haglund syndrome, patients undergo varying degrees of weightbearing limitation (weightbearing as tolerated [WBAT], partial weightbearing [PWB], touchdown weightbearing [TDWB], and nonweightbearing [NWB]). Given the scarcity of large-scale literature on the topic, the purpose of this study is to evaluate the impact of postoperative weightbearing protocols on outcomes after open surgical management of Haglund syndrome.Methods
This was a retrospective cohort study of patients who underwent open surgical management for Haglund syndrome between January 2015 and December 2023 at a single academic institution by fellowship-trained foot and ankle surgeons. Patients were excluded if they underwent concurrent operative management of additional foot pathologies. Patient demographics, comorbidities, surgical techniques, and postoperative weightbearing protocols were recorded. Complications (Achilles tendon rupture, wound breakdown/infection, persistent pain, plantarflexion weakness) and revision rates were compared across weightbearing protocols. Statistical analysis was conducted using R with significance set at P <.05.Results
Three-hundred eighty-seven patients were included (mean age 55.2 years, 66.1% female) with a mean follow-up of 10.1 (range: 0-86.3) months. The most common regimen was NWB (n = 268; 69.3%) followed by TDWB (n = 56; 14.5%), WBAT (n = 54; 14.0%), and PWB (n = 9; 2.3%). There were no significant differences in complications between the weightbearing protocols (P = .48354). Complications included persistent pain (n = 40; 10.3%), weakness (n = 6; 1.6%), wound breakdown/infection (n = 33; 8.5%), and rupture (n = 1; 0.3%)]. Revision surgery occurred in 1.8% (n = 7).Conclusion
This large cohort study found no significant association between postoperative weightbearing protocols and outcomes following open surgical treatment for Haglund syndrome at a mean follow-up of 10.1 months. This study provides evidence that surgeons can individualize appropriate weightbearing protocols based on patient needs and preferences when treating Haglund syndrome with Achilles debridement and Haglund resection.Level of evidence
Level III, comparative study.Type
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Publication Info
Hinton, Zoe W, Katherine M Kutzer, Kali J Morrissette, Kevin A Wu, Alexandra N Krez, Albert T Anastasio, Andrew E Hanselman, Karl M Schweitzer, et al. (2025). Weightbearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Large Retrospective Analysis. Foot & ankle orthopaedics, 10(1). p. 24730114251316554. 10.1177/24730114251316554 Retrieved from https://hdl.handle.net/10161/34698.
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Scholars@Duke
Andrew Egon Hanselman
I specialize in treating patients with all types of foot and ankle problems. Whether it's a simple ankle sprain or a complex foot/ankle reconstruction, I take pride in providing my patients with the expertise and resources here at Duke University but with the availability and convenience of a community-based setting. I enjoy treating patients of all ages with the goal of getting them back to their full activity as quickly and safely as possible. Most importantly, I believe in educating my patients about their issues, allowing them to better understand their health, how it affects their overall well-being, and providing them with the knowledge to become an integral part of their own healing process. Although some patients may require surgery, I try my best to maximize non-surgical treatment, knowing how much of an impact these decisions will have on someone's day-to-day life.
Karl Martin Schweitzer
My pursuit of a career in orthopaedics has come as no surprise to those around me. Growing up on our family horse farm in Mechanicsburg, Pa., afforded me many mechanical tasks. Foot and ankle orthopaedic surgery was an obvious choice: the diverse patient population, challenging surgeries, exciting research, and the ability to help my patients get back to the activities they enjoy most.
I do not take for granted my wonderful mentors throughout residency and fellowship training. I am thankful to be practicing back where my interest in foot and ankle was first ignited. My wife Samantha and I are excited to be back living in the Triangle.
As medical missionary, Dr. Albert Schweitzer said, “At times our own light goes out and is rekindled by the spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” It is my responsibility, but also privilege as a surgeon, to empower my patients with ‘that light’, through optimism, knowledge, and ultimately relief, through both non-operative and surgical means.
Samuel Bruce Adams
Mark Erik Easley
James Albert Nunley
My current research interests are both clinical and basic science. Currently, in the Orthopaedic Research Laboratory, we are investigating the biomechanical properties of the deltoid ligament in the ankle. This is a clinically relevant problem and we will hopefully identify ways to improve the correction of the adult relaxed flat foot. We are also performing a preliminary investigation into the blood supply of the distal tibia to look for a vascularized bone transfer.
We have recently completed a biomechanical study looking at the strength of fixation for proximal metatarsal osteotomies in the correction of hallux valgus and that information has been submitted for publication.
Clinical projects have looked into nerve palsies after total elbow replacement and to reconstructive upper and lower extremity surgery.
Annunziato Amendola
Chief of Sports Medicine
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