The Results of the Endoscopic Decompression for the Treatment of Haglund's Disease / 대한족부족관절학회지

PURPOSE: Haglund's disease represents a painful heel caused by mechanically induced inflammation of the retrocalcaneal bursa and insertional Achilles tendinosis may coexist. Traditional open surgery can cause complications such as skin breakdown, painful scar and altered sensation around the heel. Endoscopic treatment offers the advantages that are related to minimally invasive procedure and we evaluate the clinical results and operative techniques of endoscopic decompression of retrocalcaneal space for Haglund's disease. MATERIALS AND METHODS: Our retrospective study included seven heels in six consecutive patients for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-one years (range, 28 to 53 years). All of the patients had typical complaints of inflammation of the retrocalcaneal bursa and Fowler-Philip angle of more than 75degrees and positive parallel pitch lines were present on the lateral calcaneal radiograph. The endoscopic procedure consists of the resection of inflamed retrocalcaneal bursa and enough bone to prevent impingement of the bursa between the calcaneus and Achilles tendon. All patients were evaluated with radiologic angle, visual analogue scale (VAS) for pain and Ogilvie-Harris functional score. The mean follow-up was 18 months (range, 15 to 21 months). RESULTS: The mean operation time was 61 minutes (range, 50 to 85 minutes). VAS for pain and Fowler-Philip angle were decreased from preoperative 8.7 and 82degrees to postoperative 2.3 and 57degrees, respectively. One patient with ankylosing spondylitis had a fair result, 2 patients had good results and the remaining 3 patients had excellent results according to Ogilvie-Harris functional score. There were no surgical complications such as infection, Achilles tendon avulsion or abnormal heel sensation. CONCLUSION: The endoscopic decompression for Haglund's disease was demonstrated to have several advantages including low morbidity, allowance of functional rehabilitation, short recovery time and quick sports resumption. However a comparative study is needed to determine the value of endoscopic decompression and particular caution should be exerted for the enthesiopathy.

Radiological Change of Kager's Triangle in Patients with Retrocalcaneal Disorders / 대한족부족관절학회지

PURPOSE: The aim of this study was to analyze radiological change of Kager's triangle in patients with retrocalcaneal disorders. MATERIALS AND METHODS: Areas of Kager's triangle and calcaneus were calculated with Heron's Formula. Average of area ratio (area of Kager's triangle / area of calcaneus) was calculated for comparison and analysis, according to disease activity and aging process. One-tailed Z-test was done with the average of area ratio. RESULTS: Average of area ratio (area of Kager's trianlge / area of calcaneous) tends to decrease according to aging process and disease existence. CONCLUSION: Because area of Kager's triangle in patients with retrocalcaneal disorders tends to change according to disease activity and aging process, we should consider clinical correlation between the anatomical structure of Kager's triangle and retrocalcaneal symptoms.