The Haglund heel

Synonyms

Haglund heel, Haglund exostosis, Haglund exostosis, Calcaneus altus et latus

definition

It is the Haglund's heel around a shape variant of the calcaneus body, which is prominently formed in its side and back and can thus lead to pressure pain in the shoe. The Haglund heel is often associated with one Heel spur on.

Anatomy / structure

The heel bone (calcaneus) is part of the foot and is involved in shaping the lower ankle joint. Numerous ligaments, tendons and muscles attach to it. The Achilles tendon attaches to its rear (dorsal) part. By pulling the Achilles tendon, the foot can be lowered and the toe can be tipped. Some small foot muscles and the plantar fascia (plantar fascia) responsible for the longitudinal arch tension of the foot have their origin in the lower part of the calcaneus. The heel bone with the Tarsus in connection, upwards over the lower ankle joint with the ankle bone (talus).

CT calcaneus

CT foot sideways:

1. Metatarsal bone
2. Sphenoid bone (os cuneiforme)
3. Scaphoid bone (navicular bone)
4. Cuboid bone (os cuboideum)
5. Talus bone
6. Heel bone (calcaneus)
7. Shinbone (tibia)
8. Achilles tendon

Appointment with ?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

Cause and origin = ethiopathogenesis

In the Haglund exostosis (also Haglund heel) there is an increased ossification at the base of the Achilles tendon at the heelwhich makes the sufferer especially when wearing shoes Tenderness feel in this area.
The cause of the ossification has not yet been fully clarified. For one, there is the theory that the Haglund exostosis innate other experts suspect that the disease is also secondary Overload the Achilles tendon with the following Achilles tendonitis or badly seated Footwear can be caused. It is discussed whether a combination of these factors can also be the cause, whether the Haglund exostosis is partly congenital and can be worsened by incorrect / overstressing the heel.
This theory is supported by the fact that the Haglund exostosis is very common boys, physically active People occurs. The pressure of the edge of the shoe on the calcified tendon attachments in particular provokes the pain and is often secondary Bursitis in this area. These manifest themselves in severe discomfort when walking, pronounced pressure pain and, in many cases, swelling, reddening and overheating of the tissue.

Symptoms / complaints

Patients with painful (symptomatic) Haglund's heel report a load-dependent pain in the area of ​​the rear heel (rear foot). Ready-made footwear is only poorly tolerated. Patients often wear shoes without a heel counter. In the area of ​​the middle Achilles tendon attachment, the heel skin is reddened, swollen and sensitive to pressure. The Achilles tendon can be bulbous. Lifting the foot while pulling on the Achilles tendon causes severe pain.

Diagnosis

The medical history (anamnese) of the patient paired with the local pressure pain and the external aspect of the skin gives the decisive indication of the underlying disease of Haglund's heel.

The suspected diagnosis made in this way is X-ray of the lateral calcaneus confirmed. An extension of the upper edge of the calcaneus can be seen here.

In the Ultrasound examination are possibly a liquid-filled Bursa and to recognize a tendon swelling of the Achilles tendon.

therapy

Therapy for Haglund's heel consists of various measureswhich are combined or used individually. Basically, between conservative and operational Differentiated therapeutic measures. Ialways first the conservative Therapy used. If this is no longer sufficient, an attempt can be made surgically to remove the painful heel spur.

Conservative therapy

The primary goal of all therapeutic measures is Inflammation and pain relief, as well as the discharge of the calcaneal spur Insoles or pads. Conservative therapy consists of medicinal, physical or physiotherapeutic Measures and the right footwear.

Medical therapy

Get medication Pain medication used which at the same time a anti-inflammatory effect demonstrate (Non-steroidal anti-inflammatory drugs „NSAIDs"). Since these den Severe attack on stomach, should also include a Stomach protection be taken. Various drugs can also be injected locally.

For example, the local Cortisone infiltration strong anti-inflammatory. A local injection of Botulinum toxin harms the adjacent nerves and prevents the transmission of pain. Since an injection in the heel area is very painful, this therapy is recommended not recommended permanently. In addition, the cortisone can attack the tendons of the muscles and make them porous.

Physical therapy and physiotherapy

In addition to drug therapy, through physiotherapy exercises try to relieve the heel and strengthen the corresponding muscles. Be there local cold therapies in form of a Ice massage and doing stretching exercises on muscles and tendons. The general measures also include proper footwear and, if overweight, the Weight reduction.

Physiotherapy for Haglund's heel

Physiotherapy and stretching exercises can alleviate the symptoms of Haglund's heel and are among the first conservative measures that should definitely be taken. It mainly plays on one Strengthening and stretching the foot and calf muscles a role.
The foot and calf muscles are overloaded with the Haglund heel, irritation of the tissue occurs, which in turn causes pain. The overload of the muscles can be treated with the help of relaxation exercises.
The calf muscles are usually shortened by a Haglund heel, which can be perceived as painful. The shortened ligaments and tendons can be loosened with physiotherapy and targeted massages. In addition, special exercises to stretch the calf muscles can be performed. For example, while sitting, you can wrap a towel around your foot and hold both ends of the towel with both hands and pull it towards your body until you feel a stretch in the calf. If you do the exercise with the knee bent, the Achilles tendon stretched. See also: Stretch of the Achilles tendon

Especially in the Achilles tendon, the Haglund heel often has tendon shortenings that can be very painful.
Here, too, physiotherapy is a good way to relieve acute symptoms with the help of stretching exercises. With a simple forward lunge, for example, the Achilles tendon and the calf muscles can be stretched if the leg on the affected side is at the back. To do this, straighten the upper body and bend the front leg, the back leg is firmly on the floor and the heel is pressed down.
In everyday life, stairs are suitable for stretching the Achilles tendon by standing on the step with only your forefoot and slowly letting the affected heel hang down over the edge.
If you experience pain while stretching, you should stop stretching immediately and seek advice from a physiotherapist.

Muscle relaxation techniques are also recommended as a physiotherapeutic measure for Haglund's heel. With the help of certain physiotherapy techniques, cold or heat applications or also relaxing medication or yoga, the stressed muscles can be loosened and the discomfort and pain caused by the Haglund heel can be alleviated.

If physiotherapy is unsuccessful in relieving the symptoms, further measures and possibly surgery should be considered.

Shock wave therapy

In the Shock wave therapy become High energy sound waves used when hitting the bone and the excess bone material meet and ensure that little by little the ossifying tendon attachment is thereby reduced.

Through a special device is it possible to see the waves directly in the Area of ​​complaints to apply, this applicator is called Transducer. Generally this application of radiation is called not really painful felt. A application alone would not be sufficientto damage the unwanted bone substance, so several sessions must be scheduled in this procedure. After and after, the excess bone tissue loses its consistency and hardness and crumbles from the outside in, the body is then able to break down the resulting tissue due to the energy set from outside. The waves also stimulate the renewal of the tissue in this area. This is through small micro-injury possible, which are placed in the surrounding tissue, which stimulates 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 inflammatory substances can be easily removed - the tissue is “purged”.

The Sound waves lead to a Nerve fiber numbingwhich in turn has a positive effect on the Reduction of the pain felt affects.

The Cost of this treatment are not borne by the health insurances, so that the patient has to reckon with incurring costs. The re-formation of increased bone growth after termination of shock wave therapy is sometimes dependent on the behavior of the patient. Because such Incorrectly growing, protruding bone protrusions are mostly caused by incorrect loading and incorrect posture of the foot, so that regular physiotherapy should be carried out. You should also maintain good posture and normal movement while running and, if in doubt, use orthopedic insoles. Side effects or risks with this method of treatment are as good as no to be expected, it may come to temporary skin irritation in the irradiated area.

Read extensive information at: conservative therapy of Haglund's heel

X-ray stimulation

With this form of treatment, the affected bone area with x-rayradiation treated. The main goal, however, is not the cure, but those Rays primarily have an analgesic effect. That is, it becomes the actual underlying disease, the excessive bone growth at this point only diminishes, but not completely eliminated. Therapy usually takes place in 3 consecutive cycles. A cycle consists of 6 individual appointments. It is irradiated twice within a 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 takes place after 3 months.

This treatment can be done several times and is also used in the treatment of heel spurs, tennis elbow or arthritis. The advantage of this method is that locally very limited application of radiationwhich makes it possible to like the surrounding tissue as well as overlying tissue Muscles and skin because this radiation passes through soft tissue unhindered and then hits the bone.

A strict application to the patient group must be ensured in advance. The patients must already be 50 years old and alternative treatment methods (such as an operation) must be discussed with a doctor beforehand and carefully considered. The reason for using individual cycles is to minimize side effects. A too frequent application in the affected area in the long run would do more harm as a benefit, because X-rays are inherently harmful to cells. This should primarily be the case in the area of ​​the excess bone tissue on the Haglund heel. However, surrounding tissue must be spared. That is why the Division of radiation good protection for the surrounding tissue. The main focus here is on vascular and nerve protection.

Skin irritation can be caused by cooling ointments be prevented. Care should be taken to ensure that the irradiated tissue is spared during the period of irradiation. This means, Avoiding massages, no mechanical overload, but also the introduction of cortisone in this area should be avoided so as not to cause damage.

You can find further information under our topic: Haglund's heel irradiation.

Insert and pad

One therapy option for Haglund's heel is that conservative treatment using an insert. In the optimal case cushions the insert towards the back the heel, or the bony protrusion, and thus prevents further inflammation.

Furthermore are Running shoes with a high shoe edge to be recommended because so the Stabilized heel and is less abrasive. In addition, the heel is supported by the insole slightly raisedto shift the pressure forward, towards the toes. There are deposits of this form in every orthopedic shoe store. they should specially adapted to the foot because every Haglund heel appears differently.

A alternative represents that "Tap" or connect the heel with leukoplasty or bandage. This is probably the cheapest and most uncomplicated variant, however, care should be taken that the bandage does not slip while jogging, and is changed from time to time for hygienic reasons.

The easiest - but unfortunately only possible in the warm summer months - is of course a Running shoe with a free heel. So you can do without an insert right away. At severely obese patients also helps Diet plan for weight loss: The less weight is placed on the heel, the less it becomes mechanically stressed.

Operative therapy

Despite the various conservative options, the conservative measures often only temporarily helpful. To permanently eliminate the pain and inflammation, the root cause must be removed. This can be done as part of a surgery happen.

Surgical intervention

Is the heel bone markedly deformed, this often has to be reduced operationally. The calcaneus body is supposed to be narrowed and the protruding bone removed. An inflamed bursa can also be removed at the same time as the Haglund's heel. A minimally invasive method is the endoscopic removal of the calcaneal spur. The healing usually proceeds through the small access route without any complications. Since the Achilles tendon attachment and the plantar tendon are in direct Proximity to the operating area lying is the operation very challenging and should only by experienced surgeons be performed.

Aftercare - what to look for?

Shoe insert

There are different shoe insoles which the Relieve the heel and so can relieve the pain. There are basically two forms of insoles differentiated:

• Shoe insoles with a Recess in the heel areato relieve pressure on the heel. They prevent rubbing or pressure on the rear edge of the shoe.
• Deposits for Support of the longitudinal arch of the foot serve primarily to support the foot when walking and prevent the formation of a Flatfoot. This is one of the most common reasons for the development of a Haglund's heel and can thus prevent the symptoms from worsening.

However, neither form of shoe insole can reduce the heel spur, only that Pain symptoms and the Inflammatory situation to improve something. In any case, you should with a Haglund heel soft and spacious shoes be worn so as not to stress the heel too much. Also one Sales increase around about 1cm can help the Achilles tendon to relieve the heel and relieve the pain.

pad

In the case of an upper calcaneal spur, there are special upholstery, the so-called "Haglund upholstery“Which specifically den Protect the heel area and reduce inflammation. The cushion serves that protection the heel before pressure pointswhich can occur through the shoe. The cushion protects the heel from the upper edge of the shoe and the pain is reduced. In addition, the Heel friction on the shoe is avoided. This friction is a major cause of that Development of inflammation on the heel.

The upholstery allows the inflammation something to subside and it arises no renewed friction. In addition, the cushion can reduce the load on the Achilles tendon something to reduce and thereby also relieve pain and inflammation. For the upholstery to be of real use, it is important to use it in to wear with every shoe.

forecast

The prognosis for a successful Treatment of Haglund's heel is good.

The treatment can drag on for many weeks. Relapse symptoms after conservative therapy are common. Even after surgical therapy of Haglund's heel recurrences can occur, especially if the posterior protruding bone is not completely removed.

cure

A spontaneous healing of a Haglund heel in the advanced stage is more likely not to be expectedbecause it is a bony malformation that does not go away easily. Cause is next to congenital malformation excessive stress on the heel over a long period of time.

This can on the one hand through too intensive running training, on the other hand through poorly fitting footwear happen. Therefore, at acute pain symptoms do without running training, and the Heel cooled and elevated become. There is also different footwear and possibly one inlay advisable (see topic "Deposit").
Continue to act supportively cooling quark compresses and a Shock wave therapy such as Electricity- and Ultrasound treatment. In 1-3 sessions the bone shattered from the outside by strong energetic waves, the small pieces of bone are then automatically resorbed by the body.

The "ultima ratio" (i.e. the last possibility) represents a operative correction It is under anesthesia Chiseled off piece of protruding calcaneus, and closed the skin over it again. One such operation is only in the puffy state possible and also requires a break of several weeks until the healing process is complete. To prevent the symptoms from reappearing, you should Running training definitely only slowly and gently to be started.

The Acute case for pain treatment natural pain relievers are taken. It should be noted, however, that with prolonged use an additional Stomach protection such as pantoprazole should be taken as the freely available pain relievers NSAID class permanently damage the gastric mucosa. However, a clarification with your General practitioner or orthopedic surgeon advisable.

Summary

The complete healing the Haglund heel takes a relatively long time. If the conservative measures are implemented consistently, it will take time about 6 monthsuntil the Haglund's heel has healed completely. However, it must also follow on comfortable footwear with appropriate deposits are respected so that the Haglund's heel not redeveloped.

After a Shock wave therapy heals the heel very much much faster. After about 6 weeks the symptoms and the heel spur should be gone. In addition, no follow-up care is usually necessary. However, after the endoscopic, minimally invasive surgery the heel approx. Relief for 6 weeks and be spared. This can be done by special shoes With Sales increase and a Equinus position can be achieved. The long follow-up time serves to avoid possible complications after the operation.

Generally they are outlook for successful conservative treatment quite good. However, even after the long treatment period Relapses occur, so that the possibility of surgical therapy should be considered. Still are even after the operation renewed complaints possible. Especially when the rear Bone protrusion not completely removed has been.

The Haglund heel is more common than average with a heel spur. The cause is not entirely clear.
A heel spur is a painful bony extension on the inner body of the calcaneus (calcaneus) under the heel. The heel spur represents an ossification of a tendon plate (plantar fascia) in the attachment area.