Katherine M. Kutzer

Introduction: Haglund’s deformity, characterized by bony enlargement at the back of the heel, often coincides with Achilles tendon pathology due to impingement on the retrocalcaneal bursa and tendon insertion. Surgical management of Haglund’s deformity with a preexisting Achilles tendon rupture is complex, and understanding the outcomes of this subset of patients is essential for optimizing treatment strategies. Methods: This retrospective study reviewed patients undergoing open surgical management for Haglund’s syndrome between January 2015 and December 2023. Patients with chronic degenerative changes secondary to Haglund’s deformity and a preoperative Achilles tendon rupture were compared to those without. Data on demographics, surgical techniques, weightbearing protocols, and complications were collected. Univariate analysis was performed using χ² or Fisher’s exact test for categorical variables, and the T-test or Wilcoxon rank-sum test for continuous and ordinal variables, with normality assessed via the Shapiro–Wilk test. Results: Four hundred and three patients were included, with 13 having a preoperative Achilles tendon rupture. There was a higher incidence of preoperative ruptures among males. Surgical repair techniques and postoperative weightbearing protocols varied, though were not randomized. Complications included persistent pain, wound breakdown, infection, plantar flexion weakness, and revision surgery. While patients with Haglund’s deformity and a preoperative Achilles tendon rupture demonstrated a trend toward higher complication rates, including postoperative rupture and wound breakdown, these differences were not statistically significant in our analysis. Conclusions: A cautious approach is warranted in managing these patients, with careful consideration of surgical planning and postoperative rehabilitation. While our findings provide valuable insights into managing patients with Haglund’s deformity and preoperative Achilles tendon rupture, the retrospective design, limited sample size of the rupture group, and short duration of follow-up restrict generalizability and the strength of the conclusions by limiting the power of the analysis and underestimating the incidence of long-term complications. Therefore, the results of this study should be interpreted with caution. Further studies with larger patient cohorts, validated functional outcome measures, and comparable follow-up durations between groups are needed to confirm these results and optimize treatment approaches.

Climate change and its environmental consequences have broadly influenced human health, including the direct effects of climate-related environmental exposures increasing cancer risk. In this review, we summarize evidence and make inferences on the indirect impact of climate change on cancer etiology through three interrelated cancer risk factors—physical activity, diet, and adiposity—and how these, in turn, may have downstream effects on cancer risk. Moreover, we highlight ways in which climate change will likely exacerbate existing cancer disparities through these three cancer risk factors.

Background: Female representation among residents and practicing surgeons in orthopaedics remains disproportionately low at 19.3% and 7.4%, respectively. This study investigates female representation in speaker roles at American Orthopaedic Foot & Ankle Society (AOFAS) meetings over time. Methods: The annual AOFAS meeting programs for 2012 to 2024 were reviewed by 3 independent raters. Each speaker, moderator, and panelist was classified based on gender and role; data were cross-checked using Fleiss multirater κ validation. Sessions discussing surgical or biomedical topics were categorized as “technical,” and all other sessions were categorized as “nontechnical.” Yearly odds ratios (ORs) and CIs evaluating gender vs session status, as well as gender vs speaker role, are provided. Results: A total of 2396 speaking sessions were analyzed; 11.5% of sessions were led by female speakers. Over time, female speaker representation ranged from 5.61% in 2014 to 18.75% in 2022. Female speakers led only 10.8% of the 2088 technical sessions. On average, female speakers were significantly more likely than males to assume nontechnical speaking roles across all years combined (OR 1.5111, 95% CI 1.0792-2.1158, P = .0162). For individual year ORs, female speakers were significantly more likely to assume nontechnical speaking roles in 2020 (OR 12.24, 95% CI 4.082-36.67, P < .001); however, the differences were not statistically significant for other years. Females also comprised 10.10% and 12.00% of moderator and panelist roles, respectively. Conclusion: Female speaker involvement was representative of AOFAS female membership and the national population of female orthopaedic surgeons. Additionally, our study revealed an increasing trend in female speakers, panelists, and moderators from 2012 to 2024. However, there is a need for a shift in the distribution of speaker roles to prevent professional marginalization. Continued efforts to support female representation as role models at national conferences increases visibility and may help to address the lack of women within orthopaedics. Level of Evidence: Level III, retrospective cross-sectional study.

Background Haglund’s syndrome represents a triad of posterosuperior calcaneal bony enlargement, retrocalcaneal bursitis, and Achilles tendinopathy. This study aims to improve the understanding of patient demographics, inform surgical and perioperative decision-making, and identify complications surrounding Haglund’s resection. Methods Data were collected retrospectively from patients who received surgical treatment for Haglund’s syndrome across 6 surgeons at an academic institution from January 2015 to July 2023. Demographic and surgical technique data were collected. Additional data included weightbearing status, complications, revisions, and date of patients’ last follow-up. Descriptive statistics were completed. Results Across 390 patients, the cohort averaged 55.14 years old and was 66.4% female. Most common racial groups included Caucasian (72.8%), African American (20.8%), and Asian (1.3%). The average Body Mass Index was 34.83 with range [21.1–53.4], and 17.4% had diabetes. Additionally, 68.5% of patients reported never smoking while 30% formerly or actively smoked. Repair type was divided among SpeedBridge (57.9%), titanium knotted suture anchor (21.3%), and knotless suture anchor (20.8%). Time to last follow-up had a median of 5.8 months, with range [0 days-7 years]. Postoperative recommendations included non weightbearing (68.7%), touchdown weightbearing (14.4%), weightbearing as tolerated (13.8%), and partial weightbearing (3.1%). Overall, 78 (20.0%) patients experienced a complication, including 40 (10.3%) persistent pain, 32 (8.2%) wound breakdowns, 7 (1.8%) infection, 6 (1.5%) plantar flexion weakness, 4 (1.0%) other, and 1 (0.3%) rupture, with 7 (1.8%) requiring revision. Conclusion This retrospective study offers the largest single institution series for the operative management of Haglund’s syndrome to date with long-term follow-up. Certain patient characteristics (older age, female sex, Black or African American race, obesity, and diabetes) were prevalent in this cohort, which reflects demographics previously reported in the literature. The different repair types and weightbearing recommendations demonstrated similar trends in outcomes, with a low reoperation rate of 1.8%. Level of evidence Level III, Retrospective Cohort Study.

Introduction: The rise in youth sports participation has led to an increase in pediatric sports-related injuries in the United States, contributing to growing healthcare costs and exacerbating socioeconomic disparities. Insurance payor status is a critical factor influencing access to care, treatment delays, and health outcomes. This study examines the association between insurance payor status and outcomes in pediatric sports-related injuries. Methods: A systematic review of the Medline database was conducted. Included studies reported insurance payor status and pediatric sports orthopedic patient outcomes following surgery. Outcomes included time to be seen by a provider, treatment access, complication and revision rates, postoperative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to activity, and follow-up. Results: A total of 35 studies comprising 535,891 pediatric patients were included. Publicly insured or uninsured patients consistently experienced significant delays in accessing care, with average wait times for clinic visits, imaging, and surgery up to six times longer compared to privately insured patients. These delays were associated with worsened injury severity, higher rates of postoperative complications, and poorer functional outcomes. Publicly insured patients were less likely to receive advanced treatments such as bracing or physical therapy, further compounding disparities. Minority groups faced delays even when controlling for insurance status. Conclusions: Public and uninsured pediatric patients face systemic barriers to timely and equitable care, resulting in worse outcomes following sports-related injuries. Future research should explore targeted solutions to ensure equitable care for this vulnerable population.

Background: Following insertional Achilles tendinopathy debridement and Haglund prominence resection for Haglund syndrome, patients undergo varying degrees of weightbearing limitation (weightbearing as tolerated [WBAT], partial weightbearing [PWB], touchdown weightbearing [TDWB], and nonweightbearing [NWB]). Given the scarcity of large-scale literature on the topic, the purpose of this study is to evaluate the impact of postoperative weightbearing protocols on outcomes after open surgical management of Haglund syndrome. Methods: This was a retrospective cohort study of patients who underwent open surgical management for Haglund syndrome between January 2015 and December 2023 at a single academic institution by fellowship-trained foot and ankle surgeons. Patients were excluded if they underwent concurrent operative management of additional foot pathologies. Patient demographics, comorbidities, surgical techniques, and postoperative weightbearing protocols were recorded. Complications (Achilles tendon rupture, wound breakdown/infection, persistent pain, plantarflexion weakness) and revision rates were compared across weightbearing protocols. Statistical analysis was conducted using R with significance set at P <.05. Results: Three-hundred eighty-seven patients were included (mean age 55.2 years, 66.1% female) with a mean follow-up of 10.1 (range: 0-86.3) months. The most common regimen was NWB (n = 268; 69.3%) followed by TDWB (n = 56; 14.5%), WBAT (n = 54; 14.0%), and PWB (n = 9; 2.3%). There were no significant differences in complications between the weightbearing protocols ( P = .48354). Complications included persistent pain (n = 40; 10.3%), weakness (n = 6; 1.6%), wound breakdown/infection (n = 33; 8.5%), and rupture (n = 1; 0.3%)]. Revision surgery occurred in 1.8% (n = 7). Conclusion: This large cohort study found no significant association between postoperative weightbearing protocols and outcomes following open surgical treatment for Haglund syndrome at a mean follow-up of 10.1 months. This study provides evidence that surgeons can individualize appropriate weightbearing protocols based on patient needs and preferences when treating Haglund syndrome with Achilles debridement and Haglund resection. Level of Evidence: Level III, comparative study.