Operative treatment of Haglund's syndrome. Basics, indications, procedures, surgical techniques, results and problems

The treatment of patients with calcaneal exostosis is discussed. After unsuccessful conservative treatment, surgical procedures are advised by many authors. The open procedure for bursectomy and resection of the calcaneal exostosis is well described in the literature. The clinical studies show a high rate of poor results with a relative high incidence of complications. The minimal invasive endoscopic calcaneoplasty (ECP) could reduce these problems. The results of our first 45 patients with a mean age of 34 years (24-56 y) who underwent an ECP are promising. All patients had conservative treatment for at least 6 months and the radiological examination prior to surgery showed in all cases a calcaneal exostosis. No patient demonstrated a clinical varus deformity of the hindfoot. The average follow-up was 15.3 months (6-27). In the Ogilvie-Harris-Score 18 patients presented good and 22 patients excellent results. The post-operative radiographs showed sufficient resection of the calcaneal spur in 42 patients. The average time for endoscopic surgery in the first 10 cases was 46 min, in the subsequent cases 27 min. Neither intraoperative nor postoperative complications were observed. The ECP is an effective and minimal-invasive procedure for patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique and the pathology can better be differentiated. The comming years and the results of other groups will show, if the concept of ECP is also successful in the mid- and longterm course.