Surgical Management of Heel Pain · the calcaneus go big or go home

HAGLUND’S

SYNDROME: A TRIAD

OF PAIN

Jon Goldsmith, DPM

KPMA 2019

Annual Scientific Meeting

INTRODUCTION

◼ ANATOMY

◼ THE WORK UP

◼ HOW DO THEY WORK TOGETHER?

◼ TREATMENT

ETIOLOGY

◼ SYSTEMIC DISEASE

◼ LOCAL PATHOLOGY

◼ OSSEUS

◼ SOFT TISSUES◼ BURSA

◼ NERVES

◼ ACHILLES

HISTORY

◼ UK 1926-1927

◼ When does it hurt?

◼ Post static dyskinesia?

◼ What irritates it?

PHYSICAL

◼ LOCATION

◼ EQUINUS

◼ DIFFERENTIALS

◼ Plantar fasciitis

◼ PTTD

◼ Calc stress fracture

CONSERVATIVE TREATMENT

◼ NSAIDS

◼ HEEL LIFTS

◼ NIGHT SPLINTS

◼ IMMOBILIZATION

PHYSICAL THERAPY

INJECTION?

ESWT

◼ Bridge between conservative and surgical care

CONSIDERING SURGERY

◼ WHAT TO SURGICALLY ADDRESS

◼ PATIENT CONSIDERATIONS

◼ EXPECTATIONS

◼ OUT PATIENT

◼ POSITIONING

APPROACHES

◼ MIDLINE

◼ MEDIAL

◼ LATERAL

RETROCALCANEAL BURSA

◼ SOURCE OF PAIN

THE ACHILLES

◼ REPAIR

◼ REATTACHMENT

THE CALCANEUS

◼ GO BIG OR GO HOME

ADJUNCTIVE WORK

◼ Radio-coblation

◼ PRP

◼ MAGIC DUST

POST OPERATIVE

◼ NON WEIGHT BEARING

◼ 2 WEEKS

◼ PROTECTED WEIGHT BEARING

◼ 4 WEEKS

SUMMARY

◼ ANATOMICALLY TIED TOGETHER

◼ THE HISTORY IS CRITICAL

◼ CONSERVATIVE CARE WORKS

◼ EQUINUS