Haglund’s deformity is a pathology first described in 1928. This disease causes pain in the heel area.
Pain is initiated by tightening of the posterior-upper surface of the calcaneus. The occurrence of symptoms is most often caused by the use of too tight shoes or shoes with a stiff heel, direct injury to the heel area or intensive running training. No wonder that this disease is most often diagnosed in runners, dancers or footballers who often use too small shoes to “feel the ball better”. The reason of the bone deformity is unknown. It tends to be more common with flat feet and in women aged 15-35.
The most common symptoms of Haglund’s deformity are:
- pain in the heel area,
- thickening or damage to the skin in the painful area,
- pain upon changing type of shoes (e.g. summer shoes to winter shoes).
Pain in the heel area does not mean a diagnosis of Haglund’s deformity. A thorough clinical examination and X-ray are necessary for the correct diagnosis. It is specifically important to exclude inflammation or damage to the Achilles tendon, which may be the beginning of its complete rupture.
Often several pathologies coexist with each other, or one causes another. The exacerbation of the posterior upper edge of the calcaneus causes irritation of the deep bursa of the Achilles tendon and the tendon itself. Arising inflammation may damage the Achilles tendon.
Differentiation of pathologies:
- Haglund’s deformity,
- Achilles tendon bursitis,
- Achilles tendonitis,
- partial damage to the Achilles tendon,
- total damage to the Achilles tendon.
There are several ways to treat Haglund’s deformity. They include both conservative and surgical methods. Conservative treatment consists in the use of comfortable, non-oppressive footwear, modification of the exercises, non-steroidal anti-inflammatory drugs, physiotherapy and injections of steroid drugs into the Achilles tendon deep bursa. Particular care should be taken when administering steroid drugs, as frequently repeated injections, especially those performed without ultrasound control, may lead to Achilles tendon rupture.
Surgical treatment involves removal of bone growths from the calcaneus. Typically, such procedure is performed by cutting the skin in the heel area on the medial or lateral side. It may be accompanied by complications such as skin healing disorders, Achilles tendon rupture, damage to the peroneal nerve, weakening of the calcaneus structure, recurrence of ailments due to incomplete removal of the lesion, soreness around the postoperative scar, and finally an ugly looking scar.
An alternative to open surgery is endoscopic removal of the lesion. This surgery is performed using a camera and tools inserted through two centimeter incisions on the skin. Owing to this technique, it is possible to thoroughly remove the growths, postoperative pain is reduced and scars on the skin are minimal. On account of the possibility of early rehabilitation, the necessary interruption in training is significantly shortened.
Regardless of the method, during the procedure the patient is lying on his stomach and anesthetized from the waist down. The procedure takes 45 to 90 minutes. A hospital stay of one or two days is usually necessary. It is estimated that proper performance of the procedure relieves pain in 90% of patients.