Insoles
Orthopedic footwear can help reduce the discomfort associated with Haglund exostosis. The aim here is to reduce the strain on the ossified overbone at the heel through targeted padding or recesses in the shoe insoles. For example, there are special Haglund cushions which cushion the heel in the shoe and thus prevent over-irritation of the heel including tendon insertion.
One variant is custom-made heel shells made of silicone, which can be inserted into different shoes as desired. In addition, it is important to wear generally roomy shoes with as high a shoe edge as possible, as this also ensures that as little pressure as possible is exerted on the painful area. Insoles that raise the heel slightly (by about 1cm) can also help to relieve the pressure on the Achilles tendon.
If other foot malpositions are also responsible for the Haglund exostosis, they can also be corrected with orthopedic insoles. Since a flat foot malposition often occurs in connection with Haglund exostosis, insoles that support the longitudinal arch of the foot and bring it back to its anatomically correct position are recommended. In summer, it is recommended to wear shoes with an open heel region. Running shoes should be individually adjusted and fit optimally, as complaints occur especially after running.
Surgical treatment
The surgical treatment of Haglund’s exostosis is an intervention that should be reserved for specialists if possible. Usually this operation is performed endoscopically, which means that only a small incision is necessary, through which the surgeon gains access to the ossified zone on the calcaneus. The bony protrusion is then removed and the heel bone is narrowed overall.
At the end of the procedure, the patient is often fitted directly with a special shoe, which serves to stabilize the foot in normal position and is additionally equipped with cork plates for heel elevation. This shoe is worn continuously for several days (also at night) and is only removed for wound examination. After about 4 days, the patient may begin to put light weight on the operated foot.
The heel is first raised by 2.0-2.5 cm with the cork plates, so that the Achilles tendon is relieved.Wound healing disorders are also prevented in this way. After about a week, depending on the patient’s complaints, the foot can be fully loaded again. After ten days, the stitches are usually removed.
This is followed by a physiotherapeutic treatment, which is intended to promote mobility in the upper ankle joint in particular. The patient can then already train on the bicycle ergometer against slight resistance. After about four weeks, the heel elevation can then be gradually reduced so that about seven weeks after the operation a return to normal footwear can be attempted.
Nevertheless, a heel elevation of about 1cm should initially be inserted even in normal shoes. Only after ten weeks at the earliest can the patient return to normal weight bearing without restrictions. However, if the patient is walking more heavily, stable shoes are still recommended.
The complete treatment is finally completed after about 14-20 weeks. Overall, good results can be achieved with the surgical therapy. Especially the adequate aftercare and the consequent wearing of stable shoes with heel elevation is relevant for the surgical result. In some cases, however, relapses may still occur afterwards, but these are mainly due to insufficient removal of the ossified ganglion or to inadequate aftercare.