Definition
In medicine, exostoses (or singular exostosis: from ex = out, out and os = bone) always refer to overlegs, i.e. additional compact bones that grow outwards. Mr. Patrik Haglund was a Swedish orthopedist and surgeon after whom this exostosis is named. The terms Haglund exostosis, Haglund syndrome, Haglund pseudoexostosis can be used synonymously.
Anatomy
One of the seven tarsal bones is the calcaneus (the heel bone). This forms the heel. The Achilles tendon is attached to the calcaneus, more precisely to the tuber calcanei.
In this area bony extensions (exostoses) can occur. A distinction is made between an exostosis on the upper edge of the calcaneus, where the Achilles tendon is attached, and an exostosis on the edge of the sole of the calcaneus. One speaks of a cranial (upper) or plantar (on the sole) heel spur. A Haglund exostosis is the exostosis at the upper edge of the calcaneus in the area of the tuber calcanei
Frequency
A Haglund exostosis can be found in about 10 percent of the population. However, not all affected persons suffer from the symptoms typical for the Haglund syndrome. In Haglund exostosis (also known as Haglund heel), there is increased ossification at the base of the Achilles tendon at the heel, which causes pressure pain in this area, especially when wearing shoes.
The cause of the ossification has not yet been fully clarified. On the one hand, there is the theory that Haglund’s exostosis is congenital, while other experts suspect that the disease may also be caused secondarily by overloading the Achilles tendon with subsequent Achilles tendon inflammation or even poorly-fitting footwear. It is being discussed whether a combination of these factors can also be the cause, i.e. whether the Haglund exostosis is partly congenital and can be worsened by incorrect/overloading of the heel.
This theory is supported by the fact that Haglund exostosis occurs very frequently in young, active people. Especially the pressure of the shoe edge on the calcified tendon attachments provokes pain and often leads to secondary bursitis in this area. These manifest themselves as severe discomfort when running, pronounced pain under pressure and in many cases swelling, redness and overheating of the tissue.
