From the Guidelines
Haglund exostoses at calcaneal tuberosities should be treated with conservative measures, including wearing open-backed shoes, heel lifts, and cushioned heel pads, as initial treatment options, as recommended by the American College of Foot and Ankle Surgeons 1.
Treatment Overview
Treatment for Haglund exostoses typically begins with conservative measures to reduce pressure and inflammation.
- Wearing open-backed shoes or those with soft counters can help reduce pressure on the area.
- Heel lifts or orthoses can also help reduce pressure and alleviate symptoms.
- Anti-inflammatory medications, such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily), can help manage pain and inflammation, as suggested by 1.
- Ice application for 15-20 minutes several times daily and stretching exercises targeting the Achilles tendon and calf muscles are beneficial in reducing symptoms.
- Physical therapy focusing on eccentric heel drops may also reduce symptoms.
Further Treatment Options
For persistent cases, a corticosteroid injection around the inflamed bursa (not into the Achilles tendon) might be considered, as mentioned in 1.
- Custom orthotic devices can redistribute pressure away from the prominence.
- Surgery is reserved for cases that don't respond to 6-12 months of conservative treatment, and may involve resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa, as indicated in 1. These bony prominences develop due to repetitive friction between the heel bone and shoes, often exacerbated by high-arched feet or tight Achilles tendons, leading to inflammation of the retrocalcaneal bursa and surrounding tissues, as described in 1.
From the Research
Haglund Exostoses at Calcaneal Tuberosities
- Haglund's deformity is an abnormality of the bone and soft tissues in the foot, characterized by an enlargement of the bony section of the heel, which can trigger the condition 2.
- The aetiology of Haglund's deformity is not well known, but probable causes include a tight Achilles tendon, a high arch of the foot, and heredity 2.
- Clinical features of Haglund's syndrome include pain in the back of the heel, which is more pronounced after rest, and can be diagnosed through clinical evaluation and lateral radiographs of the ankle 2, 3.
Treatment Options
- Initial treatment for Haglund's syndrome is usually conservative and includes anti-inflammatory or analgesic agents, physiotherapy, and low-heeled, open-heeled shoes 3.
- If conservative treatment does not relieve the pain, surgery may be necessary, with options including resection of the posterosuperior calcaneal tubercle, bursectomy, excision of the Achilles tendon pathology, and endoscopic calcaneoplasty (ECP) 4, 5, 6.
- ECP has been shown to be an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis, with advantages including less morbidity, less operating time, and nearly no complications 5, 6.
Surgical Findings and Results
- Studies have reported good to excellent results in the majority of patients undergoing ECP, with sufficient resection of the calcaneal spur and minimal postoperative complications 5, 6.
- The use of ECP has also allowed for better differentiation of the pathology, including the observation of a chondral layer at the posterior aspect of the calcaneus and chondroide metaplasia of the Achilles tendon 5.