Landmarks for a Minimally Invasive Approach for Haglund's Deformity: A Cadaveric Study.

Introduction: Haglund's deformity is a posterosuperior calcaneal prominence often associated with a painful bursa and insertional Achilles tendinopathy. Endoscopic debridement has been previously described; however, the aim of this cadaveric study is to describe landmarks of a minimally invasive surgical (MIS) approach to Haglund's deformity.
Methods: Twelve specimens were dissected to identify medial and lateral portals for minimally invasive burr placement and anchor placement. A standard ruler was used to measure the distance in millimeters from the medial and lateral neurovascular structures in relation to medial and lateral portals. A separate 7-cm longitudinal incision posterior to the lateral malleolus and a separate 7-cm longitudinal incision posterior to the medial malleolus were made to identify at-risk neurovascular structures.
Results: The average distance from the sural nerve to the lateral portal was 25.7 mm (23-26). The mean distance from the lateral calcaneal branch of the sural nerve to lateral portal was 11.4 mm (10-12). The mean distance from the tibial nerve to the medial portal was 35.3 mm (35-36). Both the medial and lateral incisions were 9.3 mm from the calcaneal tuberosity.
Conclusion: The results indicate that the MIS approach to Haglund's deformity resection can be performed reliably without neurovascular compromise.
Levels of Evidence: Level IV.
Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SM and AJ have no financial disclosures to report. JC and NAS are consultants for Arthrex. The following organizations supported the institution of SM and NAS: DePuy Synthes, NuVasive Specialized Orthopedics, Orthofix, OrthoPediatrics, Paragon 28, Pega Medical, Smith & Nephew, Stryker, Turner Imaging Systems, and WishBone Medical.