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 compare the difference in forefoot width between minimally invasive extra-articular osteotomy via small incision and traditional Chevron osteotomy in the treatment of hallux valgus. Methods A retrospective analysis was conducted on the clinical data of 45 patients with hallux valgus between April 2019 and July 2022. Among them, 22 cases underwent minimally invasive extra-articular osteotomy via small incision (minimally invasive group), and 23 cases underwent traditional Chevron osteotomy (traditional group). There was no significant difference in the baseline data between the two groups (P>0.05), including gender, age, affected side, Mann classification of hallux valgus, disease duration, and preoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), bony forefoot width, soft tissue forefoot width, osteophyte width, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The osteotomy healing time and the occurrence of complications in the two groups were recorded. The differences between pre- and post-operation (changes) in various imaging indicators and AOFAS scores in the two groups were calculated. And the bony forefoot width and soft tissue forefoot width at 1, 6, and 12 months after operation were also recorded and compared between the two groups. Results One case of skin injury occurred during operation in the minimally invasive group, while 3 cases of poor wound healing occurred after operation in the traditional group. None of the patients experienced infections, nerve injuries, or other complications. All patients were followed up 12-31 months (mean, 22.5 months). The osteotomy healed in the two groups and no significant difference in healing time between the two groups was found (P>0.05). The IMA, HVA, DMAA, osteophyte width, and AOFAS score at 12 months after operation significantly improved compared to those before operation (P<0.05). There was no significant difference between the two groups in the changes of IMA, HVA, and osteophyte width (P>0.05). However, the differences in the changes of AOFAS score and DMAA were significant (P<0.05). There was no significant difference between the two groups in bony and soft tissue forefoot widths at different time points after operation (P>0.05). However, there were significant differences in the two groups between the pre- and post-operation (P<0.05). Conclusion The minimally invasive extra-articular osteotomy via small incision for hallux valgus, despite not removing the medial osteophyte of the first metatarsal, can still effectively improve the forefoot width and osteophyte width. While correcting the IMA and HVA, it can more effectively restore the DMAA, resulting in better AOFAS scores.