Operative Repair of Achilles Tendinopathy with Haglund Deformity in Diabetes

Research Type Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose Diabetes mellitus affects the treatment of lower extremity pathologies, including Achilles tendon disorders. Non-enzymatic glycosylation leads to tendon stiffening and altered gait mechanics. While the effects of diabetes on Achilles tendon structure are well-studied, its impact on Insertional Achilles Tendinopathy with Haglund deformity (IAT-HD) remains unclear. This study compares surgical and patient-reported outcomes between diabetic and non-diabetic patients undergoing IAT-HD repair. Methods This retrospective cohort study included adult patients who underwent insertional Achilles tendon repair with Haglund's deformity between 2017 and 2022. Patients were stratified by the presence of diabetes mellitus. Key demographic factors, surgical characteristics, and comorbidities were collected. The primary outcome was functional improvement, measured by FAAM scores at 1- and 2-year follow-ups. Secondary outcomes included readmissions, revisions, time to weight-bearing, physical therapy, and complications. Results A total of 18 diabetic patients and 132 non-diabetic patients were included. Baseline demographics and surgical characteristics were similar between groups. Diabetic patients showed higher rates of 90-day and more than 90-day readmissions, revisions, debridement, retear, and a decrease in FAAM score at 1-year, although these differences were not statistically significant. Conclusion Patients with diabetes exhibited similar surgical and patient-reported outcomes after operative management of IAT-HD compared to non-diabetic patients. These findings suggest that surgical intervention for IAT-HD is safe in diabetic patients, providing valuable information for preoperative counseling and risk stratification.