ObjectiveTo 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. MethodsA 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. ConclusionCompared 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.
Objective To investigate the effectiveness of spring ligament repair combined with subtalar arthroereisis (STA) and the Kidner procedure for treating children’s flexible flatfoot with painful accessory navicular. Methods A retrospective analysis was conducted on clinical data from 45 children (45 feet) aged 7-14 years with flexible flatfoot and painful accessory navicular who met the selection criteria and were treated between February 2018 and May 2022. Among them, 23 cases (23 feet) were treated with spring ligament repair combined with STA and Kidner procedure (observation group), while 22 cases (22 feet) received STA with Kidner procedure alone (control group). Comparison of baseline data between the two groups including gender, age, affected side, preoperative visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, talonavicular coverage angle (TCA), talus-first metatarsal angle (T1MT), talus-second metatarsal angle (T2MT), talus first plantar angle (Meary angle), calcaneal inclination angle (Pitch angle) showed no significant differences (P>0.05). The following parameters were recorded and compared between the two groups: operation time, intraoperative blood loss, incision length, hospital stay, time to full weight-bearing, and complication rates. Foot pain and functional recovery were assessed using the VAS score and AOFAS score preoperatively and at last follow-up. Radiographic measurements including TCA, T1MT, T2MT, Meary angle, and Pitch angle were analyzed by comparing preoperative to last follow-up values. Results Both groups of patients successfully completed the surgery without any procedure-related complications such as vascular, neural, or tendon injury. The operation time in the observation group was significantly longer than that in the control group (P<0.05). There was no significant difference between the two groups in terms of intraoperative blood loss, incision length, hospital stay, or time to full weight-bearing (P>0.05). All patients were followed up 23-47 months (mean, 33.7 months). In the control group, 1 patient experienced discomfort during walking, attributed to screw irritation in the sinus tarsi, which resolved after 2-3 months of rehabilitation. None of the remaining patients developed complications such as sinus tarsi screw loosening, peroneal tendon contracture, or wound infection. At last follow-up, the observation group showed significantly better improvements in radiographic parameters (TCA, T1MT, T2MT, Meary angle, Pitch angle) and greater reductions in VAS and AOFAS scores compared to the control group (P<0.05). Conclusion The combined procedure of spring ligament repair, STA, and Kidner procedure for children’s flexible flatfoot with painful accessory navicular demonstrates significant improvements in foot appearance, arch collapse correction, and pain relief. This technique offers technical simplicity, minimal intraoperative complications, and satisfactory clinical outcomes.