Disclosures: Kyungje Sung, MD: No financial relationships or conflicts of interest

Case Diagnosis: 8 patients (age ranged between 37- 65; 5 Females, 3 Males) underwent a percutaneous guided minimally invasive treatment with osteotomy device (TX-Bone by Tenex Health, Lake Forest, California) using ultrasound guidance to resect a Haglund deformity.

Case Description: Haglund deformity is an enlargement of the posterosuperior calcaneus and can be associated with retrocalcaneal bursitis and insertional Achilles tendinopathy. We present an alternative minimally invasive technique to resect the Haglund deformity using a percutaneous ultrasound guided osteotomy device. The method involves a small 3-4 mm incision to guide the cutting device through the Achilles tendon and advanced from a distal to superior angle to engage the pathologic bone. The cutting device is then activated and repositioned to resect the Haglund deformity. The procedure is performed using local anesthesia. In this series, 8 patients with painful Haglund deformities underwent this percutaneous approach, and pre- and post-procedure pain scores with the numeric rating scale (NRS) were recorded and complications documented.

Setting: Outpatient Musculoskeletal ClinicAssessment/

Results: Patients had follow-up visits at 2 weeks, 8 weeks, and 16 weeks. Patients had a mean pre-procedure NRS of 5.8/10 and mean post-procedure NRS of 2.3 at 2 weeks, 3.2 at 8 weeks and 2.7 at 16 weeks. The average time spent immobilized in a walking boot ranged between 2-4 weeks. Complications after the procedure included thermal burn over treated area (n=2), and increased foot swelling (n=1).

Discussion: To our knowledge, this is the first reported case series reporting patient outcomes following an ultrasound guided percutaneous Haglund resection with an osteotomy device. The advantage of this approach is that the procedure is performed using ultrasound guidance and local anesthesia, and preserves the Achilles tendon.

Conclusion: This approach is less invasive and provides an alternative to open or endoscopic calcaneoplasty, with potentially a faster recovery and return to daily activity and sports.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-novel-approach-to-haglund-deformity-resection-using-a-percutaneous-ultrasound-guided-osteotomy-device-a-technique-description-and-case-series/