Original Research Surgical Correction of Haglund’s Triad Using a Central Tendon-Splitting Approach: A Retrospective Outcomes Study Zhan Xia, MBBS 1 , Andy Khye Soon Yew, BEng, PhD (Mech Eng) 2 , Ting Karen Zhang, BSc (Immunol) 3 , Hsien Ching David Su, MBBS, MRCS (Edinb), MMed (Ortho Surg), FRCS (Edinb) 4 , Yung Chuan Sean Ng, MBBS, MRCS (Edinb), MMed (Ortho Surg), FRCS (Edinb) 4 , Inderjeet Singh Rikhraj, MBBS, FRCS (Glasg), FAMS 5 1 Orthopaedic Resident, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 2 Research Scientist, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 3 Senior Executive, Orthopaedic Diagnostic Center, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 4 Consultant, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 5 Associate Professor and Senior Consultant, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore article info Level of Clinical Evidence: 4 Keywords: central tendon-splitting approach Haglund’s triad surgical correction abstract We evaluated the surgical outcomes of Haglund’s triad using a central tendon-splitting approach, with Achilles tendon partial detachment and debridement, excision of the retrocalcaneal bursa, resection of Haglund’s prominence, and reattachment of the Achilles tendon. The medical records of 22 patients (22 heels) who had undergone surgical correction of Haglund’s triad from January 2010 to December 2015 were reviewed retrospectively. The visual analog scale pain score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical and mental component scores were prospectively collected preoperatively, 6 months postoperatively, and at the last visit. The scores of a subjective question involving satisfaction were prospectively collected at the last visit. Possible risk factors were also evaluated. We reviewed the data from 12 females and 10 males, with the mean age of 59.2  7.3 years and a mean follow-up duration of 15.1  4.6 months. Significant improvement was found in the mean visual analog scale pain score, average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical component scale score. The overall satisfaction rate was 77.3% (17 of 22). Postoperative complications included 2 cases of delayed wound healing and 1 case of sensation loss over the heel wound. No Achilles tendon rupture or wound infection developed. Gender and body mass index did not affect the surgical outcomes. The surgical technique we used for Haglund’s triad provided effective pain relief, function improvement, and overall enhancement of patients’ health condition. More research is required to further evaluate the outcomes of our surgical approach to treat Haglund’s triad and the possible risk factors. Ó 2017 by the American College of Foot and Ankle Surgeons. All rights reserved. Posterior heel pain is a common condition encountered by foot and ankle surgeons. The pain can result from Haglund’s deformity, insertional Achilles tendinosis, or retrocalcaneal bursitis. Clinically, any of these pathologic entities can present as an isolated condition; when all 3 occur together, they comprise Haglund’s triad (1). Haglund’s deformity was first described by Patrick Haglund in 1928 as a clinically evident prominence in the posterolateral heel that developed in association with the wearing of rigid low-back shoes in “cultured people” (2). This condition most commonly affects females in their twenties (3). Clinically, posterior heel pain and inflammation is present that is significantly aggravated by shoe wear and can be relieved by walking barefoot or wearing open-heeled shoes. In addition, tenderness lateral to the Achilles tendon and a palpable posterior lateral prominence will be present. Radiographic measurements, including Fowler’s angle and parallel pitch lines, are commonly used to assess the degree of prominence (4,5). As a result of this prominence, ankle dor- siflexion and shoe counter pressure usually cause inflammation of the Financial Disclosure: None reported. Conflict of Interest: None reported. Address correspondence to: Zhan Xia, MBBS, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169856. E-mail address: williamxia0402@gmail.com (Z. Xia). 1067-2516/$ - see front matter Ó 2017 by the American College of Foot and Ankle Surgeons. All rights reserved. http://dx.doi.org/10.1053/j.jfas.2017.05.015 Contents lists available at ScienceDirect The Journal of Foot & Ankle Surgery journal homepage: www.jfas.org The Journal of Foot & Ankle Surgery xxx (2017) 1–7