Patient characteristics, postoperative protocols, and surgical outcomes in Haglund's resection: a single-institution retrospective cohort study.

Background: Haglund's syndrome represents a triad of posterosuperior calcaneal bony enlargement, retrocalcaneal bursitis, and Achilles tendinopathy. This study aims to improve the understanding of patient demographics, inform surgical and perioperative decision-making, and identify complications surrounding Haglund's resection.

Methods: Data were collected retrospectively from patients who received surgical treatment for Haglund's syndrome across 6 surgeons at an academic institution from January 2015 to July 2023. Demographic and surgical technique data were collected. Additional data included weightbearing status, complications, revisions, and date of patients' last follow-up. Descriptive statistics were completed.

Results: Across 390 patients, the cohort averaged 55.14 years old and was 66.4% female. Most common racial groups included Caucasian (72.8%), African American (20.8%), and Asian (1.3%). The average Body Mass Index was 34.83 with range [21.1-53.4], and 17.4% had diabetes. Additionally, 68.5% of patients reported never smoking while 30% formerly or actively smoked. Repair type was divided among SpeedBridge (57.9%), titanium knotted suture anchor (21.3%), and knotless suture anchor (20.8%). Time to last follow-up had a median of 5.8 months, with range [0 days-7 years]. Postoperative recommendations included non weightbearing (68.7%), touchdown weightbearing (14.4%), weightbearing as tolerated (13.8%), and partial weightbearing (3.1%). Overall, 78 (20.0%) patients experienced a complication, including 40 (10.3%) persistent pain, 32 (8.2%) wound breakdowns, 7 (1.8%) infection, 6 (1.5%) plantar flexion weakness, 4 (1.0%) other, and 1 (0.3%) rupture, with 7 (1.8%) requiring revision.

Conclusion: This retrospective study offers the largest single institution series for the operative management of Haglund's syndrome to date with long-term follow-up. Certain patient characteristics (older age, female sex, Black or African American race, obesity, and diabetes) were prevalent in this cohort, which reflects demographics previously reported in the literature. The different repair types and weightbearing recommendations demonstrated similar trends in outcomes, with a low reoperation rate of 1.8%.

Level Of Evidence: Level III, Retrospective Cohort Study.