Is calcaneal osteotomy justified in Haglund's disease?

Purpose of the study The authors report their experience of Zadek's wedge osteotomy in the treat ment of posterior talalgia in adults and evaluate the various radiographica l measurements for calcaneus deformity measurement... Material This procedure was performed in 27 patients with a total of 36 calcanea tre ated between 1985 and 1946. The sex ratio was 20 women for 7 men with an av erage age of 27 years. Prior to this osteotomy nine feets were operated by resection of the postero-superior tuberosity with recurrence of pain and di sability, and two patients presented an inflammatory arthritis. Method For the surgical procedure, the patient was placed in lateral position. Ski n incision was five to six centimeters long, curvilinear along the lateral side of the tendo achillis. Two dorsal pins were inserted, creating a trian gle so that the apex pointed plantarly and the base dorsally. The sagittal saw was then used to create a wedge osteotomy with a dorsal base of seven t o ten millimeters. A screw was then driven across the osteotomy site for ul timate fixation. Results Eighty per cent (29 osteotomies) of patients had been examined clinically a nd radiologically with a mean follow-up of 29 months. Considering pain, daily activity and discomfort with footwear, results were excellent in 12 cases, good in 10, fair in 5 and poor in two cases. No radiological criteria used for the diagnosis of Haglund's disease were a bsolutely reliable. The "total angle" of Ruch, the "c.l angle" of Chauveaux and the "parallel pitch lines" of Heneghan reflect the amount of deformati on most accurately, but especially, the calcaneal inclination angle was alw ays increased (16 cases between 18 degrees and 30 degrees, 6 cases > 30 deg rees). All patients had a weight-bearing calcaneal talus, either alone or i n the context of posterior pes cavus. Conclusion This study confirms the responsability of rearfoot morphostatic disorders i n posterior talalgia and the goods results obtained by Zadek osteotomy.