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Syndrome is a condition characterized by the growth of a painful bump in the heel area. Patients with this syndrome may experience pain, swelling, tightness, impaired function, and difficulty fitting footwear. The syndrome is composed of several components, including:\u003C\u002Fp>\u003Cp>1. \u003Cstrong>Haglund's Growth\u003C\u002Fstrong> - a bony protrusion in the calcaneus's posterior part. It is caused by retroversion of the calcaneus, which is a backward tilt, resulting in an increased risk of bony growth.\u003C\u002Fp>\u003Cp>2. \u003Cstrong>Retrocalcaneal Bursitis\u003C\u002Fstrong> is an inflammation of the oil sac between the heel bone and the Achilles tendon. It is constantly aggravated when there is a reduction in space between the bony growth and the tendon.\u003C\u002Fp>\u003Cp>3. \u003Cstrong>Achilles Tendon Insertional Tendinopathy \u003C\u002Fstrong>occurs when the area of the Achilles tendon that attaches to the heel bone is constantly pressed by bone growth. As the tendon degenerates, it becomes overgrown by nerve endings, blood vessels, and calcium deposits form in the Achilles tendon.\u003C\u002Fp>\u003Cp>4. \u003Cstrong>Retrocalcaneal Enthesophyte \u003C\u002Fstrong>is an additional bony outgrowth that forms behind the Achilles tendon, further increasing the growth of the heel.\u003C\u002Fp>\u003Cp>\u003C\u002Fp>\u003Cp>\u003Cstrong>Conservative treatment of Haglund's syndrome\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>The primary treatment for Haglund's deformity includes modifying workload, cold compresses, eccentric strengthening exercises, extracorporeal shock wave therapy, silicone heels, and footwear with a softer or open heel. Corticosteroid injections are only recommended in the retrocalcaneal bursa and should be performed together with ultrasound. While NSAIDs may help reduce pain, they won't stop the growth of the deformity. It's important to note that the benefits of conservative measures are limited and short-term. Therefore, they won't prevent the progression of the condition.\u003C\u002Fp>\u003Cp>For a long-term solution, the Percutaneous Zadek osteotomy is an effective option. In this operation, a keel-shaped incision is made in the calcaneus to replace the retroversion and retract the Haglund's growth from the retrocalcaneal bursa and the Achilles tendon. This eliminates the cause of irritation of the Achilles tendon, reduces pain, and restores movement.\u003C\u002Fp>\u003Cp>\u003C\u002Fp>\u003Cp>\u003Cstrong>Why is percutaneous Zadek osteotomy preferred over standard open surgery in the absence of contraindications?\u003C\u002Fstrong>\u003C\u002Fp>\u003Cul>\u003Cli>\u003Cp>The area around the Achilles tendon has poor blood flow, which makes open surgery for this area risky and increases the chances of wound complications. However, we have found that these complications can be significantly reduced by performing surgery through small, percutaneous incisions.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>The Zadek osteotomy is a type of surgery that doesn't involve lifting the Achilles tendon, unlike the standard open Haglund excision and reinsertion of the Achilles tendon. This is beneficial because bone healing with bone is more effective than tendon healing with bone, which reduces the risk of postoperative tendon rupture and shortens the rehabilitation period.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>This surgery also results in less postoperative soreness, which means that less pain medication is needed. Additionally, the operated leg can be partially used just two weeks after the operation.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>To reduce the risk of deep vein thrombosis of the legs, a wearable plaster cast and a postoperative boot are used for up to 6 weeks after surgery. A postoperative boot in a neutral position is also better tolerated by patients.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>This type of surgery is suitable for professional athletes as well. After the surgery, the function of the affected area improves and returning to professional sports takes an average of 21 weeks.\u003C\u002Fp>\u003Cp>\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Cp>\u003Cstrong>The course of the operation\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>The surgery is carried out with the patient either under general or regional anesthesia while lying on their side. With the aid of X-ray guidance and using small incisions of 3-5 mm, a keel-shaped incision is made in the calcaneus. This is then crushed and closed with special drills, and percutaneous fixation with two screws is carried out. This change in biomechanics eliminates the cause of the pathological process.\u003C\u002Fp>\u003Cp>In some cases, the surgery may be combined with posterior arthroscopy of the ankle joint. This further reduces the Haglund growth and removes the inflamed sac at the back of the heel - known as the retrocalcaneal bursa.\u003C\u002Fp>\u003Cp>\u003C\u002Fp>\u003Cp>\u003Cstrong>After surgery, it is recommended to follow the steps below for best results:\u003C\u002Fstrong>\u003C\u002Fp>\u003Cp>1. Wear a plaster cast and avoid touching the leg for the first 2 weeks after the operation.\u003C\u002Fp>\u003Cp>2. Keep the operated foot elevated for 23 hours a day during the first 2 weeks.\u003C\u002Fp>\u003Cp>3. Use blood thinners for the first 2 weeks to reduce the risk of deep vein thrombosis.\u003C\u002Fp>\u003Cp>4. Visit the doctor for wound inspection 1-2 weeks after surgery.\u003C\u002Fp>\u003Cp>5. Use a special postoperative boot (set at a 90-degree angle) with partial weight bearing, based on crutches, for up to 6 weeks after the operation (20% weight on days 14-28; 50% weight on days 28-42).\u003C\u002Fp>\u003Cp>6. After 6 weeks, take control x-rays to confirm bony healing.\u003C\u002Fp>\u003Cp>7. Start wearing normal comfortable shoes and put full weight on the operated leg.\u003C\u002Fp>\u003Cp>8. Gradually return to normal physical activity starting 6 weeks after surgery.\u003C\u002Fp>\u003Cp>9. Do not drive a car for 9 weeks after surgery. If the operation was on the left leg, it's possible to drive a car with an automatic transmission shortly after the operation.\u003C\u002Fp>\u003Cp>10. Do not use nicotine (cigarettes, cigars, electronic cigarettes, etc.) for 6 weeks before and after surgery. This will reduce the risk of thrombosis, surgical wounds, and bone infections by 2 times and bone failure by 2.5 times.\u003C\u002Fp>\u003Cp>11. Take a Vitamin D (1000 IU) and calcium (500 mg) supplement for 6 weeks before and after surgery.\u003C\u002Fp>\u003Cp>12. Take a large dose of Vitamin C (500-1000 mg) for 6 weeks before and after surgery. This will reduce the risk of pain syndrome.\u003C\u002Fp>\u003Cp>13. Do not use non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, etc.) 3 days before and 6 weeks after surgery.\u003C\u002Fp>\u003Cp>\u003C\u002Fp>\u003Cp>\u003Cstrong>How to prepare for surgery\u003C\u002Fstrong>\u003C\u002Fp>\u003Cul>\u003Cli>\u003Cp>It is important to have the following x-rays taken for your first visit: foot and ankle lateral, anterior ankle, and forefoot (dorsoplantar) STANDING and FULL WEIGHT BEARING.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>While magnetic resonance imaging is not mandatory, it is recommended to assess retrocalcaneal bursitis and thickening of the Achilles tendon and rule out other pathologies that may manifest with similar symptoms.\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>You should also have blood tests done no more than 4 weeks before surgery, including a general blood test, Urea, Creatinine, electrolytes, clotting factors, and a Vitamin D test. If you have diabetes, make sure to have test results of glycosylated hemoglobin (HbA1c) no older than 4 weeks. 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