Symptomatology

Not every person with a Haglund exostosis suffers from symptoms that are due to this bone protrusion. Symptoms can be triggered by excessive physical exertion, incorrect footwear (chronic pressure on the exostosis area) or foot malpositions. Constant stress on the surrounding structures leads to the characteristic symptoms. The reason for this is an irritation up to and including inflammation of the Achilles tendon, the bursa between the Achilles tendon and the calcaneus (bursa subachillea, in case of inflammation one speaks of bursitis subachillea) or the periosteum of the calcaneus. This is noticeable by the following symptoms:

Pain when pressing on the lower Achilles tendon The point of attachment on the heel bone
Pain in the heel area, especially under stress (e.g. sports)
Swelling and redness of the heel area

Diagnostics

Often the description of the pain and the typical local findings (redness and pressure pain over the heel) already lead to the suspicion of a Haglund’s syndrome. To confirm the diagnosis, an x-ray of the foot and in particular of the heel should also be made, where the described exostosis can be seen. Bursitis subachillea can be detected by ultrasound examination of the affected region.

At first, a Haglund exostosis should always be treated conservatively, i.e. without surgery. Conservative therapy options In most cases, it is sufficient to relieve the affected area. This is achieved by changing the (sports) shoes.

Soft shoes are preferable. In addition, the shoes in the heel area should not end at the level of the exostosis. In addition, specially manufactured insoles can help to correct causal malpositioning and thus prevent permanent irritation of the exostosis.

If this is not sufficient, physical therapy can be used to alleviate the symptoms. These include the use of cold and heat treatments, as well as local ultrasound therapy. This should in particular cause a reduction in inflammatory activity or irritation.

Shock wave therapy also offers a possibility to alleviate the complaints. Here, high-energy ultrasound waves are used to reduce inflammation and minimize calcification. However, the costs of shock wave therapy are usually not covered by health insurance.If the conservative measures show no improvement over a period of 9 to 12 months, surgery should be considered.

In this case, the bone projection is removed with a chisel. In the case of chronic inflammation of the bursa (bursitis subachillea), this may also have to be removed. The Achilles tendon is also partially removed during the operation and then reattached to the heel with bone anchors.

However, the operation does present some complications. For example, scar tissue may form in the area of the operation, which can be very painful.

In most cases, it is sufficient to relieve the affected area.
This is achieved by changing the (sports) shoes. Soft shoes are preferable. In addition, the shoes in the heel area should not end at the level of the exostosis.

In addition, specially manufactured insoles can help to correct causal malpositioning and thus prevent permanent irritation of the exostosis.
If this is not sufficient, there is the possibility to alleviate the symptoms by physical therapy. These include the application of cold and heat treatments, as well as local ultrasound therapy. This should in particular cause a reduction in inflammatory activity or irritation.

If the conservative measures show no improvement over a period of 9 to 12 months, surgery should be considered.

Approximately 80% of the patients operated on are free of complaints after the operation. After the operation, a plaster splint must first be worn for several weeks before the foot can be fully loaded again. Full athletic ability is reached after three months if the operation proceeds without complications. However, the operation does present some complications. For example, scar tissue may form in the area of the operation, which can be very painful.