In 1928, the Swedish orthopedic surgeon, Patrick Haglund,¹ described a condition involving a painful osseous prominence of the posterolateral corner of the calcaneus, large posterior callus, and retrocalcaneal bursitis. In the absence of Achilles tendinopathy, a Haglund deformity can be addressed by performing an exostectomy of the calcaneus. Open and endoscopic techniques have been described for this. The complication rate for open surgery in one study is 12.3% (range, 0%-53%).² The complications reported included transient paresthesia around the wound (4.3%), superficial infection (3%), incision site tenderness (0.8%), delayed wound healing (0.6%), heel numbness (0.6%), extensive hematoma (0.6%), Achilles tendon rupture (0.4%), complex regional pain syndrome (0.2%), hypertrophic scar (0.2%), sural nerve neuropathy (0.2%), and deep vein thrombosis (0.2%).² Endoscopic techniques, on the other hand, have demonstrated a significantly lower complication rates of 5.3% (range, 0%-18%).² Such complications include superficial wound infection (1.8%), sural nerve neuropathy (0.9%), delayed wound healing (0.6%), heel numbness (0.6%), portal site tenderness (0.6%), deep vein thrombosis (0.3%), Achilles tendon rupture (0.3%), and complex regional pain syndrome (0.3%).² Endoscopic resection of the Haglund deformity is technically difficult, deterring less experienced surgeons or those who do not routinely employ arthroscopic techniques in their practice. For such reason, the use a fully percutaneous technique might be of interest to surgeons less willing to use an arthroscope but nonetheless eager to perform the procedure through a keyhole incision that should minimize soft-tissue complications.

The diagnosis of Haglund syndrome is generally straightforward with obvious posterior heel pain, swelling, and redness. Tenderness is reported at the posterolateral “bump,” the retrocalcaneal burse anterior to the Achilles tendon. Of note, posteromedial bumps are more suggestive of an insertional Achilles tendinopathy instead of a true Haglund syndrome. Most patients are young adults, physically active, who complain of pain when walking or exercising. The pain dissipates with rest and often improves with the use of heels or a small heel lift.