Master Techniques in Orthopaedic Surgery: The Foot and Ankle

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24 Haglund Deformity With Flexor Hallucis Longus Tendon Transfer

FIGURE 24.12 A. The tendon is pulled through into the tunnel. B. Tendon secured with 7 × 25 mm interference screw. C. Completed flexor hallucis longus tendon augmentation. Closure is routine.

PEARLS AND PITFALLS

●● Avoid lateral position if considering a tendon-splitting approach ●● Gentle skin handling

●● Flexing the knee and plantarflexing the foot relieves tension on the Achilles tendon if required ●● Adequate bony resection must be achieved to ensure decompression of the retrocalcaneal space

●● Cautious dissection around the FHL tendon to protect the tibial nerve ●● Adequate débridement is important in achieving symptomatic relief

POSTOPERATIVE MANAGEMENT

●● Consider thromboprophylaxis, especially for high-risk patients ●● Splint in plantar flexion with posterior (+/− anterior) slab of plaster of Paris ●● Wound check 10 days ●● Immobilization in an orthopedic walking boot with heel lift for 6 weeks if greater than 50% of the tendon insertion is detached or an augmentation procedure is performed ●● Physiotherapy to regain gastrocnemius-soleus strength RESULTS AND COMPLICATIONS We have found that a significant improvement in pain and function can be expected after this surgery, which is also supported in the literature. 10 Patient satisfaction for this procedure is typically reported as between 85% and 95% satisfied. The complication rate in the literature is between 15% and 35% with most of those complications being considered “minor” such as scar hypertrophy and hypersen sitivity. While these issues may be considered minor, they do contribute to patient dissatisfaction. 11 There are also some potential serious problems that the patient should also be aware of including infection, 12,13 Achilles tendon rupture or avulsion, nerve injury, and persistent pain. Wound problems are a source of worry around the Achilles tendon, and great care should be taken when handling the

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