What is the treatment for Haglund deformity Achilles tendonitis?

From the Guidelines

Treatment for Haglund deformity Achilles tendonitis should begin with conservative measures, including rest, ice, and NSAIDs, before considering surgical options. The goal of treatment is to reduce inflammation, relieve pain, and promote healing of the affected tendon. According to 1, rest prevents ongoing damage, reduces pain, and may promote tendon healing, although the duration of rest is not well defined.

Conservative Treatment

• Rest and avoid activities that worsen pain
• Ice application for 10-minute periods, as recommended by 1, to reduce swelling and pain
• NSAIDs, such as ibuprofen or naproxen, for pain and inflammation
• Physical therapy, including calf stretching and eccentric heel drop exercises, to strengthen supporting muscles and improve biomechanics
• Footwear modifications, such as avoiding shoes with rigid backs and using heel lifts, to reduce pressure on the deformity
• Custom orthotic devices to redistribute pressure away from the painful area
• Night splints to maintain ankle dorsiflexion during sleep

Advanced Treatment Options

• Corticosteroid injections, used cautiously due to rupture risk, for persistent cases
• Extracorporeal shock wave therapy, which may be beneficial for chronic cases
• Surgery, typically reserved for cases that don't respond to 6-12 months of conservative treatment, to remove the bony prominence and relieve pressure on the tendon.

It's essential to note that the treatment approach should be individualized, and the patient should be closely monitored for progress and potential complications. As stated in 1, tensile loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibers, making eccentric exercise a beneficial component of treatment.

From the Research

Treatment Options for Haglund Deformity Achilles Tendonitis

• Initial treatment is usually conservative and includes:
  • Anti-inflammatory or analgesic agents 2
  • Physiotherapy 2
  • Low-heeled, open-heeled shoes 2
• If conservative treatment does not relieve the pain, surgery may be necessary 2, 3
• Surgical options may include:
  • Tendon debridement and reattachment using the Arthrex Speedbridge® system 3
  • Surgical resection of the prominence 4
• Other treatment options that have been explored include:
  • Platelet rich plasma (PRP) treatment for chronic Achilles tendinosis 5
  • Removal of calcification at the tendon insertion 6

Characteristics of Haglund's Deformity

• Haglund's deformity is an enlargement of the posterosuperior prominence of the calcaneus 6
• It is frequently associated with insertional Achilles tendinitis 6
• Characteristics of Haglund's deformity include:
  • Haglund's deformity height and peak angle 6
  • Presence of calcification in the Achilles tendon 6
  • Bohler's angle and Fowler-Philip angle 6
  • Parallel pitch sign 6

Diagnosis and Imaging

• Diagnosis is based on clinical signs and radiological images 2
• Imaging studies such as MRI and/or ultrasound may be used to confirm the diagnosis and evaluate the extent of the condition 5
• Measurements such as Haglund's deformity height and peak angle may be used to assess the severity of the condition 6