SymptomsComplaints | The Haglund – Heel

SymptomsComplaints

Patients with a painful (symptomatic) Haglund’s heel report a load-dependent pain in the area of the rear heel (hindfoot). Ready-made shoes are poorly tolerated. Often patients wear shoes without heel cap.

In the area of the middle Achilles tendon insertion, the heel skin is reddened, swollen and pressure-sensitive. The Achilles tendon may be bulbous. Lifting the foot by pulling on the Achilles tendon causes severe pain.

Diagnostics

The patient’s medical history (anamnesis), coupled with the local pressure pain and the external aspect of the skin, gives the decisive indication of the underlying disease of the Haglund’s heel. The suspected diagnosis is confirmed by an x-ray of the lateral heel bone. Here an extension of the upper calcaneal margin is visible. The ultrasound examination may reveal a fluid-filled bursa and a distension of the Achilles tendon.

Therapy

The therapy of the Haglund heel consists of various measures, which can be applied in combination or individually. Basically, a distinction is made between conservative and operative therapy measures. The conservative therapy is always applied first. If this is no longer sufficient, surgery can be attempted to remove the painful heel spur.

Conservative therapy

The primary goal of all therapeutic measures is the relief of inflammation and pain, as well as the relief of the heel spur through insoles or pads. The conservative therapy consists of medicinal, physical or physiotherapeutic measures and the right footwear. Painkillers are used medicinally, which simultaneously have an anti-inflammatory effect (non-steroidal anti-rheumatic drugs “NSAIDs”).

Since these attack the stomach strongly, an additional stomach protection should be taken. Various local medications can also be injected. For example, local cortisone infiltration has a strong anti-inflammatory effect.A local injection of botulinum toxin damages the adjacent nerves and prevents pain transmission.

Since an injection in the heel area is very painful, this therapy is not recommended permanently. In addition, the cortisone can attack the tendons of the muscles and make them porous. In addition to drug therapy, physiotherapeutic exercises can be used to try to relieve the heel and strengthen the corresponding muscles.

Local cold therapies in the form of an ice massage and stretching exercises of the muscles and tendons are performed. The general measures also include the right footwear and, in the case of overweight, weight reduction. Particularly in the Achilles tendon, the Haglund’s heel often causes tendon shortening, which can be very painful.

Here, too, physiotherapy is a good way to alleviate acute complaints with the help of stretching exercises. With a simple forward lunge, for example, stretching of the Achilles tendon and calf muscles can be achieved when the leg of the affected side is at the back. To do this, straighten the upper body and bend the front leg, the rear leg stands firmly on the floor and the heel is pressed down.

In everyday life, steps are suitable for stretching the Achilles tendon by standing on the step with the front foot only and letting the affected heel slowly hang down over the edge. If you experience pain when stretching, you should stop stretching immediately and consult your physiotherapist. As a physiotherapeutic measure, muscle relaxation techniques are also recommended for the Haglund heel.

With the help of certain physiotherapeutic techniques, cold or heat applications or even relaxing medication or yoga, the stressed muscles can be loosened and the discomfort and pain caused by the Haglund’s heel can be relieved. If physiotherapy is not successful in relieving the symptoms, further measures and possibly surgery should be considered. Shock wave therapy uses sound waves with high energy, which hit the bone and the excess bone material when it hits the bone and ensure that the ossifying tendon attachment is gradually reduced.

A special device makes it possible to apply the waves directly in the area of the complaints, this applicator is called a transducer. In general, this application of radiation is not perceived as really painful. One application alone would not be enough to damage the unwanted bone substance, so several sessions must be scheduled in this procedure.

Gradually, the excess bone tissue loses its consistency and hardness and crumbles from the outside inwards. The body is then able to break down the accumulated tissue due to the energy provided from the outside. Furthermore, the waves also stimulate the renewal of the tissue in this area.

This is made possible by small micro-injuries that are set in the surrounding tissue, which stimulate the body to become active in this area and to form new, healthy tissue. The blood circulation in the irradiated area is increased and waste products and also inflammatory substances can be easily removed – the tissue is “purified”. The sound waves lead to an anaesthetic of the nerve fibers, which in turn has a positive effect on the reduction of the felt pain.

The costs of this treatment are not covered by health insurance companies, so the patient must reckon with costs incurred. The renewed formation of increased bone growth after termination of the shock wave therapy is sometimes dependent on the patient’s behavior. This is because such malformed, protruding bone protrusions are usually caused by incorrect loading and incorrect posture of the foot, so that regular physiotherapy should be carried out.

In addition, attention should be paid to good posture and normal movement when running and, in case of doubt, orthopedic insoles should be used. Side effects or risks associated with this treatment method are virtually non-existent, and temporary skin irritation may occur in the irradiated area. In this form of treatment, the affected bone area is treated with X-rays.

However, the primary goal is not healing, but rather the radiation primarily relieves pain. This means that the actual underlying disease, the excessive bone growth at this point, is only reduced but not completely eliminated. Normally, the therapy takes place in 3 consecutive cycles.

One cycle consists of 6 individual appointments. It is irradiated twice within one week, so that a period of 3 weeks is calculated for one cycle.The 2nd cycle follows after about 2 months and the 3rd cycle follows after 3 months. This treatment can be repeated several times and is also used to treat a heel spur, tennis elbow or arthritis.

The advantage of this method is that the radiation is very localized, which makes it possible to spare the surrounding tissue and the tissue above it, such as muscles and skin, because the radiation passes unhindered through soft tissue and then hits the bone. Strict application with regard to the patient group must be ensured in advance. Patients must be 50 years old and alternative treatment methods (e.g. surgery) must be discussed with a physician in advance and carefully considered.

The background of the application of single cycles is to minimize the side effects. Too frequent application in the affected area in the long term would mean more harm than good, because X-rays are in themselves cell-damaging. This should also be the case primarily in the area of excess bone tissue at the Haglund’s heel.

Surrounding tissue must, however, be spared. Therefore, the distribution of the radiation offers good protection for the surrounding tissue. The main focus here is on the protection of vessels and nerves.

Skin irritations can be prevented by cooling ointments. Care should be taken to protect the irradiated tissue during the time of irradiation. This means avoiding massages, no mechanical overloading, but also the introduction of cortisone in this area should be avoided in order to avoid damage.

One therapeutic option for the Haglund’s heel is conservative treatment with an insert. Ideally, the insole cushions the heel or the bony protrusion towards the back, thus preventing further inflammation. Furthermore, running shoes with a high heel edge are recommended, as this stabilizes the heel and reduces chafing.

In addition, the heel is slightly raised by the insole to shift the pressure forward to the toes. Insoles of this shape are available in every orthopedic shoe store. They should be specially adapted to the foot, since every Haglund heel has its own individual appearance.

An alternative is to “tap” or connect the heel with Leukoplast or bandage. This is probably the cheapest and most uncomplicated option, but care should be taken to ensure that the bandage does not slip while jogging and should be changed from time to time for hygienic reasons. The easiest – but unfortunately only realizable in the warm summer months – is of course a running shoe with a free heel. This way you can do without an insole right away. For very overweight patients, a dietary plan also helps to reduce weight: the less weight the heel is exposed to, the less mechanical stress it is subjected to.