Haglund's syndrome.

Haglund's syndrome is a painful condition of the heel caused by mechanically induced inflammation of the retrocalcaneal bursa, supracalcaneal bursa, and Achilles tendon. Surgical management has included calcaneal osteotomy, but results have been unpredictable because of the inability to measure accurately bone removal. A method was devised in this study to accurately determine radiographically the amount of bone removal necessary. Sixteen heels in 13 patients underwent surgery after failing 21 months of conservative treatment. The desired osteotomy angle (preop x-rays) was compared to the actual angle obtained at surgery. A patient questionnaire, developed by the Outcome Study Committee of the AOFAS, was used to assess results. There were 13 good results and 3 failures. The average actual angle of the good results was 49 degrees and that of the poor results was 61 degrees. These results were statistically significant to a p = .0012. The average score obtained by the good results was 87 points, while that of the failures was 25 points. Follow-up was 42 months. The authors recommend that the osteotomy be made in such a way as to remove not only the superolateral deformity, but also to decompress the retrocalcaneal bursa and to remove the calcaneal step. In order to do so, an osteotomy angle of 49 degrees should be achieved.