yogabuch / pathologie / haglund-heel

Haglund-heel(Haglund-exostosis, -syndrome)

Definition of

Exostosis of the dorsal calcaneus first described by the Swedish orthopaedic surgeon Patrick Haglund in 1928, in which the calcaneus forms a dorsal exostosis. This can cause the insertion of the Achilles tendon to thicken. The increased pressure against the shoe leads to irritation, swelling and inflammation of the soft tissue, including bursitis subachillae. If the syndrome is not very advanced, it is more likely to be characterized by pain on starting the run, which decreases as the distance walked or run increases, but care should still be taken as the soft tissues are severely affected. Over time, the irritation of the Achilles tendon leads to calcium deposits, which are also visible on X-rays and can lead to a secondary dorsal heel spur. Haglund’s heel occurs unilaterally or bilaterally. Achillodynia (degenerative, less inflammatory damage to the Achilles tendon), as a pure insertional tendinopathy and the primary pure dorsal heel spur are relevant in the differential diagnosis.

Predisposing

1. Hollow foot
2. High training load on the Achilles tendon
3. Shoes that are too tight
4. ill-fitting, too wide shoes in which the foot slips, especially during sport
5. Running on flat, hard surfaces, uphill running
6. Overweight
7. shortened triceps surae
8. Lack of exercise (poor training condition)
9. Longer pointed foot postures as with stomach sleep

Diagnosis

1. X-ray to assess the bone and calcification. Determination of the Fowler-Philips angle (angle between the dorsal surface of the calcaneus and the plane through the dorsal protrusions) in the Achilles tendon.
2. Contrast MRI for the assessment of soft tissue

Symptoms

1. sudden, knife-like pain
2. Visible and palpable thickening of the dorsal calcaneus
3. Signs of inflammation
4. In the early stages, pain on starting exertion, later also permanent pain on exertion when walking

Complications

1. dorsal heel spur
2. Bursitis subachillae

Therapy

1. Rest: training break or load reduction or adaptation
2. Increasing the heel with insoles to relieve the triceps surae and Achilles tendon
3. Heel pad
4. Thermotherapy (heat or cold)
5. Ultrasound
6. Anti-inflammatory drugs
7. Shock wave therapy
8. if necessary: weight reduction
9. PT
10. Consistent stretching of the triceps surae
11. pre-existing damage to the Achilles tendon may be an indication for surgery: if necessary, debridement of the Achilles tendon, removal of the exostosis or soft tissue-preserving Zadek osteotomy. If necessary: Bursectomy. Good prognosis, but recovery takes time
12. If you have a hollow foot: appropriate foot exercises

DD

1. Achillodynia
2. primary dorsal heel spur