Haglund's Disease

What is Haglund's disease?

Haglund's disease corresponds to a conflict between the ventral, deep side of the Achilles tendon and the posterosuperior part of the calcaneus or heel bone. Above the insertion of the Achilles tendon on the calcaneus, there is a bursa that allows painless gliding of the Achilles tendon over the posterosuperior process of the calcaneus. In the case of a Haglund-type conflict, the bursa becomes inflamed, hardens, and thus becomes painful. An Achilles tendon tendinopathy, called corporeal Achilles tendinopathy, and an insertional Achilles tendinopathy can be associated with Haglund's disease. A para-tendinopathy of the Achilles may also contribute to the pain.

What are the symptoms of Haglund's disease?

The symptoms of Haglund's disease are pain and bursitis.

• The pain of Haglund falls within the scope of posterior heel pain, and consists of mechanical heel pain (talalgia).
• The pre-Achilles and retro-Achilles bursae can become inflamed and painful, which is known as bursitis.
• The pre-Achilles bursitis is located between the front side of the Achilles tendon and the posterosuperior process of the calcaneus. There is an increase in the thickness of the tissues on both sides of the Achilles tendon, both medially and laterally. Pressure on the posterosuperior process of the calcaneus is painful.
• The superficial retro-Achilles bursitis is located laterally to the Achilles tendon, between the posterolateral process of the calcaneus and the skin. It does not affect the Achilles tendon. There is painful thickening of the tissues with episodes of swelling, and skin discoloration may also be seen over the posterolateral edge of the calcaneus.

Treatments for Haglund's disease

In the initial stage, during the first 6 months, there is inflammation of the retrocalcaneal bursa. If there is a predisposing factor, such as a change in footwear for athletes, it is necessary to correct it quickly. The onset of pain may correspond to changing from one brand of sports shoe to another, or even just changing models. If you return to your old shoes, the same brand, or even the same model, you may be able to completely relieve your pain.

Functional treatment of Haglund's disease: shoes

We remind you of the importance of buying your shoes in a half-size to one size larger depending on the sports shoe brand, especially for jogging, running, or hiking.

You should feel comfortable right away. If you think you need to "break in" your shoes before running with them, they are not suitable and may cause you pain.

The problem also arises with leather shoes with a rigid heel counter; you should not count on "breaking in" your shoes before wearing them for an entire day. In general, the heel counter will get the better of your heel.

Medical treatment of Haglund's disease

Medical treatment is symptomatic. Taking painkillers, non-steroidal anti-inflammatory drugs, and icing the heel can help relieve pain.

Cortisone injections are not recommended, as they may weaken the Achilles tendon and its insertion, increasing the risk of rupture. Hyaluronic acid injections are of limited effectiveness.

Haglund's disease surgery: what are the options?

The possibilities for surgical intervention depend on the combination of lesions involving the Achilles tendon, the insertion of the Achilles tendon, and the conflict with the posterolateral process of the calcaneus. The morphology of the foot and heel must be taken into account in the treatment.

Osteotomy of the posterolateral process or calcaneoplasty.

This procedure consists of resecting the posterolateral process of the calcaneus and the bursitis by performing a bursectomy and a calcaneoplasty, that is, a “reshaping” of the calcaneus…

Arthroscopy is indicated for this procedure, as it helps to limit the risk of scarring.

Achilles detachment and reinsertion with calcaneoplasty.

This procedure consists of detaching the tendon while maintaining its continuity, removing tendon and insertion calcifications, performing a calcaneoplasty, and then reinserting the Achilles tendon.

It treats issues of conflict with the posterolateral process of the calcaneus, with calcifications of the Achilles insertion and of the tendon itself.

Zadek’s calcaneal osteotomy

This procedure consists of performing a dorsal closing osteotomy of the calcaneus. It removes conflict with the posterolateral process of the calcaneus and relieves the Achilles insertion.

It may be indicated in cases of high-arched foot and long calcaneus according to Tourné’s criteria.

Haglund's disease after surgery: Postoperative recovery

It depends on the procedure performed.

• In the case of resection of the posterolateral process of the calcaneus by arthroscopy, there is no immobilization of the ankle postoperatively, and walking is resumed immediately, using two crutches for 15 days. Driving is resumed after 1 month. It may be considered the day after the procedure if the surgery was on the left ankle and you have an automatic car.
  Rehabilitation, when necessary, begins 1 and a half months after surgery, and consists of stretching the posterior muscle chains, especially the gastrocnemius, massaging the Achilles tendon, and possibly performing eccentric contraction exercises of the triceps surae, that is, the calf muscles, following the Stanish rehabilitation method.

• In case of detachment and reattachment of the Achilles tendon, it is necessary to immobilize the ankle in a cast for 3 weeks to allow skin healing, then after removing the cast, a walking boot should be worn for another 3 weeks, with gradual weight-bearing using two crutches.
  Rehabilitation can begin 1 and a half months after the procedure. It also consists of stretching the posterior muscle chains, especially the gastrocnemius, massaging the Achilles tendon and its insertion, and possibly performing eccentric contraction exercises of the triceps surae, that is, the calf muscles, following the Stanish rehabilitation method.

• For a calcaneal osteotomy of the Zadek type, the ankle is immobilized in a cast for 45 days, then the walking boot is worn for another 45 days. Bone consolidation of the Zadek osteotomy takes 3 months, and another 3 months should be allowed for bone remodeling.
  Rehabilitation can begin 1 and a half to 3 months after the procedure.

Exercises and stretches for the posterior muscle chains

Retraction of the posterior muscle chains, of the sural-achilleo-plantar system, also called retraction of the gastrocnemius or twins, is a factor that aggravates the pain of Haglund’s disease. It is a recurring problem for foot and ankle pain as well.

There are self-rehabilitation exercises that you can do at home to stretch these muscles. In some cases, we prescribe rehabilitation sessions such as the “Mézières” method.