Conservative therapy of the Haglund heel
The general conservative therapy measures of the Haglund’s heel include everything that contributes to a reduction of the pressure load on the heel. This includes:
- Heel cushion with punched insert
- Expansion and soft bedding of the heel cap
- High shoe edge
- In summer shoes with free heel
- Weight reduction
- Temporary reduction of physical strain.
The same physical therapy measures are used as in the treatment of the calcaneal spur. The physical therapy measures include cold and heat applications as well as ultrasound treatments.
with NSAIDs and cortisone (e.g. Voltaren®, Ibuprofen®) in tablet form and ointment bandages can provide relief of symptoms. local infiltrations of narcotics and cortisone should rather not be used. Due to the immediate proximity and involvement of the Achilles tendon, cortisone-induced tendon fiber death can occur, which leads to weakening of the Achilles tendon and can cause an Achilles tendon rupture.
Shock wave therapy is also successfully used. Very high-energy mechanical waves are directed at the painful region. The inflammation is supposed to be removed by an ingrowth of blood vessels.
At the same time, the ossification is gradually dissolved. This therapy of the Haglund’s heel with the shock wave takes 6 weeks. Treatment is carried out in 2-3 sessions at approximately weekly intervals.
The costs of the individual sessions amount to 50-100 Euros and are not covered by the health insurance. Various studies, however, have been able to prove the positive effect of shock wave therapy. Shock wave therapy is a high-energy mechanical wave that is generated outside the human body.
They are transferred to the body through a water-filled cushion. The shock waves are then concentrated in the bony process of the Haglund’s heel and break up the disturbing tendon calcifications. The disturbing heel spur is thereby pulverized into smallest particles.
In addition, the shock waves promote the blood circulation in the tissue and thus the healing process. The advantage of this therapy is the possibility of outpatient treatment without anesthesia. The therapy takes place in 2-3 sessions with a one-week interval.
Physiotherapy and stretching exercises can alleviate the symptoms of Haglund’s heel and are among the first conservative measures that should be taken. Strengthening and stretching of the foot and calf muscles plays an important role. With the Haglund heel, the foot and calf musculature is overstressed and the tissue is irritated, which in turn causes pain.
The overloading of the musculature can be treated by means of relaxation exercises. The calf muscles are usually shortened by a Haglund’s heel, which can be felt as painful. Physiotherapy and targeted massages can be used to loosen the shortened ligaments and tendons.
In addition, special exercises can be performed to stretch the calf muscles. For example, while sitting, a towel can be wrapped around the foot and both ends of the towel can be held with both hands and pulled towards the body until a stretch is felt in the calf. If the exercise is performed with the knee bent, the Achilles tendon is also stretched.
Especially in the Achilles tendon, the Haglund 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.Treatment with X-rays should only be carried out on a Haglund’s heel after all other measures have been tried without achieving any improvement.
If surgery on the Haglund’s heel is not possible or should be avoided, irradiation is a possible treatment option. Inflammatory soft tissue or connective tissue diseases such as a: can usually be treated with good treatment success by radiation. The foot is irradiated in an X-ray tube for a few minutes at a time over a period of a few weeks.
As a rule, one can assume a treatment period of five weeks, twice a week. The treatment itself only takes a few minutes and is painless. The main purpose of the irradiation is to relieve the pain caused by the Haglund’s heel.
In most cases this is successful, since in about 70 to 100 percent of the cases the pain associated with the Haglund’s heel can be successfully relieved by radiation. The disadvantage of irradiation is that X-rays damage the cells and the higher the radiation dose, the more damage can be caused to the body tissue by the radiation. The radiation dose is lower than in cancer therapy, for example, but should not be underestimated.
According to the current state of knowledge, irradiation of a Haglund’s heel is associated with very few acute side effects or late effects of radiation and should improve the blood circulation and metabolism of the cells in the inflamed tissue around the Haglund’s heel. Due to the risks involved, irradiation of a Haglund’s heel should only be considered if conventional therapy and the administration of painkillers have not been successful in alleviating the symptoms. However, it is assumed that the earlier the Haglund’s heel is irradiated, the more likely it is that the treatment will be successful.
According to the current state of knowledge, irradiation does not eliminate the cause of the complaints, so it does not lead to the disappearance or destruction of the Haglund’s heel. Instead, only the inflammation in the surrounding tissue and the pain associated with it are treated.
- Haglund heel
- Heel spur
- Arthrosis
- Tennis elbow or
- Benign vascular tumors
