Haglund's heel (ICD code M77.3) is an abnormal shape of the heel bone. It leads to pain and inflammation of the bursa between the bone and the Achilles tendon.
Below you will find further information and selected Haglund's heel specialists.
In some people, the rear/upper part of the heel bone is more pointed and protrudes further than usual. This creates a bottleneck between the bone and the Achilles tendon running behind it. For this reason, the soft tissues are under greater pressure and greater strain. The consequences are
in this area. A bursa located between the heel bone and the Achilles tendon, which acts as a kind of shock absorber, is often irritated and swells.
In Haglund's heel, the heel bone is more pointed and protrudes further © rob3000 | AdobeStock
The Swedish orthopaedic surgeon Patrik Haglund first described the condition in 1928. The attachment of the Achilles tendon to the upper heel bone is often inflamed. There is also a bony protrusion at the attachment point, which alters the tensile properties of the tendon on the calcaneus.
In combination with the increased shoe pressure, the altered tension causes what is known as Haglund's syndrome. It manifests itself through
Haglund's heel is also referred to as a posterior heel spur. This must be distinguished from the anterior or lower (plantar) heel spur, which is located on the sole of the foot.
Common triggers for a Haglund's heel are
The resulting pressure irritation of the Achilles tendon often triggers bursitis between the tendon and the heel bone. In addition, the exostosis often affects the Achilles tendon itself as well as the periosteum of the calcaneus.
If the pressure and irritation persist for a long time, all the soft tissues in this area may swell. This results in a clearly visible bump.
Haglund's heel occurs both unilaterally and bilaterally. Pressure pain and swelling occur where the heel bone rubs against the inside of the shoe.
At the beginning of the disease, those affected only feel pain during the first few steps (initial pain). This quickly disappears again.
If this warning sign is ignored, the pain and inflammation often increase again. In the long term, those affected can no longer walk or run normally.
The entire area often turns red and swells. The protruding upper part of the heel bone can be seen on the heel.
As a rule, doctors recognize the presence of Haglund's exostosis from the symptoms described above. They usually occur both under stress and at rest.
A lateral X-ray makes the bony overbone visible. The assessment always takes into account the clinical symptoms and heel pain.
Doctors use an ultrasound examination to clarify the condition of the Achilles tendon. They examine the tendon for thickening, which indicates the extent to which it is already involved in the disease process of Haglund's exostosis. This examination also reveals existing bursitis and swelling.
Haglund's heel can also affect the Achilles tendon © bilderzwerg / Fotolia
Magnetic resonance imaging (MRI) with contrast medium is almost indispensable for the appropriate treatment of Haglund's heel. This allows the affected soft tissues, i.e. the Achilles tendon, bones and bursa, to be examined in detail. At the same time, the examination makes calcium deposits in the Achilles tendon visible.
In principle, there are surgical and conservative treatment methods. Surgical measures are in the foreground, while conservative treatment involves symptomatic local therapy including pain medication. In most cases, conservative therapy can be carried out first, which is often successful. Surgical treatment is only recommended at an early stage after a frustrating course or clear and increasing bony changes.
The most important treatment goal is to relieve the heel pain and restore the foot's ability to bear weight in everyday life or during sport.
To relieve the heel area as quickly as possible, it is advisable to wear loose footwear, ideally shoes that are open at the back. Insoles to raise the heel by about one centimetre also take the pressure off the painful area. They reduce the pull of the Achilles tendon on the heel bone.
Runners should refrain from training until they feel relief. To prevent a loss of endurance and strength, it is advisable to switch to aqua jogging during the training-free period and to carry out targeted muscle training. Returning to running training too early can lead to chronic Achilles tendon problems and cause permanent restrictions in running performance.
Painkillers and anti-inflammatory drugs such as ibuprofen and aspirin help to reduce swelling and pain in the joint. In addition, various methods from the field of physical therapy are available for the conservative treatment of Haglund's heel. These include
Ice packs and cool curd compresses are recommended for self-therapy.
In particularly severe cases, complete immobilization of the foot in a cast or orthosis is necessary. This can provide sufficient relief for the ankle joint and stop the inflammation.
Conservative therapy often has to be carried out over a longer period of time before treatment is successful. Several months are normal.
If there is still no satisfactory improvement after six months, a surgical procedure is recommended.
Surgery is particularly necessary in the case of high training loads. Athletes cannot permanently relieve the strain on their heel. Surgery is also advisable in cases where the constant pressure has a damaging effect on the Achilles tendon.
The following procedures are available for Haglund's heel surgery:
Removal of the bony protrusion on the heel bone reduces the pressure of the heel against the inner edge of the shoe. This also protects the
permanently relieved. It is then possible to wear shoes again without pain and to train in shoes.
The procedure is usually performed under partial anesthesia. However, general anesthesia is also possible on special request. First, a three to four centimeter incision is made on the side of the Achilles tendon. This is then held aside to expose the back of the calcaneus and the bursa.
Parts of the bony prominence are then removed, usually using an oscillating saw. This special saw allows the Achilles tendon, bursa and soft tissue to be spared as much as possible. Finally, the area is sutured and the joint is immobilized with a recumbent cast for the lower leg.
The stitches are removed after about two weeks. Until the stitches are removed, it is essential to avoid putting weight on the foot, which is why a recumbent cast is also applied. Premature weight-bearing can jeopardize the success of the operation.
If everything is in order at the check-up, you will then be given a walking cast that will allow you to put increasing weight on the foot.
For some years now, minimally invasive procedures have also been used for surgical treatment, in which special instruments are used to access the joint via small stab incisions. Here too, anesthesia of the leg is necessary; the principle of removing the bony protrusion and cleaning the tissue corresponds to the open procedure described above.
If a malposition of the foot is the cause of Haglund's heel, repositioning the heel bone is one of the most important treatment concepts. Orthopaedics offers various repositioning operations that can be adapted precisely to the patient's individual case.
For example, it is possible to correct a hollow foot deformity with a calcaneal osteotomy and effectively treat the resulting exostosis. Osteotomy means that the bone is sawn through and the bone ends are reconnected in a different position. Immobilization is also necessary here. In addition, metal implants are used to stabilize the position of the bone ends in relation to each other.
Such an operation is followed by at least six to eight weeks of rest with a break from training. The patient then begins to gradually put weight back on the foot and heel area.
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