Weightbearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Retrospective Analysis

Category: Ankle; Hindfoot Introduction/Purpose: Surgical options to address Haglund deformity include endoscopic and open approaches. After surgery, patients receive varying degrees of weightbearing limitation (nonweightbearing, touchdown weight bearing, or partial weight bearing). Given the scarcity of large-scale literature on the topic, this study aims to evaluate the impact of postoperative weightbearing protocols on outcomes after open surgical management of Haglund Syndrome. Methods: Following institutional approval, a retrospective review of patients undergoing surgery at a single institution by *** providers for Haglund Syndrome was performed. Patients were included if the surgery was performed by a currently active, fellowship-trained Foot and Ankle orthopaedic surgeon, without simultaneous management of other foot pathologies. This cohort of patients was reviewed for the following variables: date of birth, body mass index (BMI), smoking status (never, quit, active), American Society of Anesthesiologists Physical Status Classification (ASA), date of surgery, laterality, type of repair (corkscrew, speed bridge, suture anchor), current procedural terminology codes (CPT), postoperative weightbearing recommendations, postoperative outcomes (Achilles rupture, wound breakdown, persistent pain, debilitating plantarflexion weakness, revision), and date of most recent follow up. Statistical analysis was conducted using R with statistical significance set at p < 0.05. Results: Across 390 patients, the cohort averaged 55.14 years old and was 66.4% female. Postoperative recommendations varied from NWB (68.7%), TDWB (14.4%), WBAT (13.8%), and PWB (2.3%). Overall, 75 (19.2%) patients experienced a complication, including 40 (10.3%) persistent pain, 32 (8.2%) wound breakdowns, and 1 (10.3%) rupture, with 7 (1.8%) requiring revision. There were no significant differences in characteristics including age, diabetes, gender, BMI, and smoking status between weightbearing protocol groups. There were no statistically significant differences in complication rate between weightbearing protocols (p= 0.48354). The WBAT group experienced the highest rate of pain (14.8%) and a higher rate of the need for revision surgery in the WBAT group (3.7%), though not significant. The highest rate of wound breakdown occurred in the NWB group (9.7%). Conclusion: The study suggests that postoperative weightbearing protocols do not significantly influence the outcomes of open surgical treatment for Haglund Syndrome. This indicates that surgeons may choose the most appropriate weightbearing protocol based on individual patient needs and preferences. Future research should aim to further validate these findings and explore the impact of postoperative immobilization on outcomes in more granular detail.