Effectiveness of all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement in treatment of Haglund’s disease_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIA Rongzhi , XUE Yang , KONG Dehai , ZHANG Yang ,  SUN Guangchao

Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China;

Corresponding?author：

SUN Guangchao, Email: sunguangchao1984@126.com

Keywords：

Haglund’s disease; arthroscopy; gastrocnemius contracture; aponeurosis release

DOI：

10.7507/1002-1892.202509009

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Objective To investigate the effectiveness of all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement in the treatment of Haglund’s disease complicated with gastrocnemius aponeurosis contracture. Methods A retrospective analysis was conducted on the clinical data of 50 patients with Haglund’s disease complicated by gastrocnemius aponeurosis contracture, who were admitted and met the selection criteria between April 2020 and March 2022. Based on the surgical approach, the patients were divided into an observation group (26 cases, 26 feet, undergoing all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement) and a control group (24 cases, 24 feet, undergoing open Achilles tendon insertion debridement only). There was no significant difference (P>0.05) in baseline data between the two groups, including gender, age, body mass index, affected side, preoperative Fowler-Philip angle (FPA), visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Victorian Institute of Sport Assessment-Achilles (VISA-A) score, and ankle dorsiflexion range of motion (ROM). Surgical duration, incision length, intraoperative blood loss, time to return to daily activities and sports, and incidence of complications were recorded and compared between the two groups. FPA was measured at 1 month after operation and the changes before and after operation were calculated. Functional recovery was evaluated by comparing VAS score, AOFAS ankle-hindfoot score, VISA-A score, and ankle dorsiflexion ROM before operation and at 1, 3, 12 months after operation. Results The observation group had a longer surgical duration but lower intraoperative blood loss and shorter incision length compared to the control group, with all differences being significant (P<0.05). One patient in the observation group experienced postoperative limb numbness, while 3 patients in the control group developed incision redness and swelling, all of which resolved after symptomatic treatment. The remaining patients showed good postoperative incision healing, with no complication such as infection or neurovascular injury occurring in any case. All patients were followed up 12-20 months, with an average of 18.3 months. The observation group had shorter recovery time for both daily activities and sports activities compared to the control group (P<0.05). There was no significant difference between the two groups in the preoperative to postoperative change in FPA (P>0.05). In both groups, the VAS scores, AOFAS ankle-hindfoot scores, VISA-A scores, and ankle dorsiflexion ROM showed significant improvement at each postoperative time point compared with preoperative values, furthermore, all these indicators continued to improve progressively over time postoperatively, with all differences being significant (P<0.05). At each postoperative time point, the AOFAS ankle-hindfoot scores, VISA-A scores, and ankle dorsiflexion ROM in the observation group were significantly better than those in the control group (P<0.05), with ankle dorsiflexion ROM showing particularly superior improvement. However, no significant difference was observed in VAS scores between the two groups (P>0.05). At 12 months postoperatively, according to the VISA-A scores, the observation group achieved excellent results in 20 cases and good in 6 cases, while the control group achieved excellent results in 10 cases and good in 14 cases. The excellent and good rates were 100% in both groups. Conclusion Compared with open Achilles tendon insertion debridement alone, the all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement demonstrates superior efficacy in improving ankle ROM, promoting functional recovery of the foot, and minimizing surgical trauma for the treatment of Haglund’s disease complicated by gastrocnemius aponeurosis contracture.

Citation： JIA Rongzhi, XUE Yang, KONG Dehai, ZHANG Yang, SUN Guangchao. Effectiveness of all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement in treatment of Haglund’s disease. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(2): 285-290. doi: 10.7507/1002-1892.202509009 Copy

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4. Cattolico A, Sergio F, Boemio A, et al. Preliminary anatomical and surgical assessment of combined percutaneous resection and proximal medial gastrocnemius release vs historical controls in treating haglund syndrome: A mixed prospective-retrospective study. Foot Ankle Orthop, 2025, 10(3): 24730114251372601. doi: 10.1177/24730114251372601.
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6. Lieber AM, Malempati M, Kelly M, et al. Minimally invasive surgery technique is safe and effective for the treatment of haglund deformity. Foot Ankle Spec, 2025, 1: 19386400251383426. doi: 10.1177/19386400251383426.
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Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement in treatment of Haglund’s disease

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