Comparison of dorsal closing wedge calcaneal osteotomy versus posterosuperior prominence resection for the treatment of Haglund syndrome

Abstract

Background Haglund syndrome is a common disease that causes posterior heel pain. This study compared the clinical outcomes of dorsal closing wedge calcaneal osteotomy (DCWCO) and posterosuperior prominence resection (PPR) for the treatment of Haglund syndrome. Methods This retrospective study included 12 patients who underwent DCWCO and 32 patients who underwent PPR from January 2010 to August 2016. Patients were evaluated using the American Orthopedic Foot Ankle Society ankle-hindfoot scale (AOFAS), for Achilles tendinopathy (VISA-A), Fowler-Philip angle, Bohler's angle, and calcaneal pitch angle preoperatively and postoperatively (at 3 months, 6 months, 1 year, and the latest follow-up). Results Both groups exhibited a significant increase in their AOFAS and VISA-A scores after surgery. The DCWCO group had lower AOFAS scores than the PPR group at 6 months (77.6 +/- 5.1 vs. 82.8 +/- 7.8; P = 0.037) but had higher scores at the latest follow-up (98.2 +/- 2.3 vs. 93.4 +/- 6.1; P = 0.030). The DCWCO group had lower VISA-A scores at 3 months (56.9 +/- 13.9 vs. 65.2 +/- 11.0; P = 0.044) but higher scores at the latest follow-up (98.2 +/- 2.6 vs. 94.3 +/- 5.0; P = 0.010) than the PPR group. Both groups exhibited significant changes in the Fowler-Philip angle and Bohler's angle after surgery. The postoperative Fowler-Philip angle of the DCWCO group was greater than that of the PPR group (35.9 degrees +/- 4.9 degrees vs. 31.4 degrees +/- 6.2 degrees; P = 0.026). However, there was no statistically significant difference in any other angle of the two groups postoperatively. Conclusions Compared to the PPR group, the DCWCO group had poorer short-term clinical outcomes but provide better long-term function and symptom remission. This method can be a good option for those patients with higher functional expectations.