Treating Haglund’s Syndrome

Haglund’s syndrome refers to a posterosuperior calcaneal abnormality which is characterised by a bony prominence located anterior to the insertion of tendoachilles.

This leads to posterior heel pain caused by mechanical compression of adjoining soft tissues, with the patient presenting a combination of Achilles tendinopathy, retrocalcaneal and retro-Achilles bursitis.

Kucuksen et al. differentiate Haglund’s deformity from Haglund’s syndrome by classifying the latter as involving a painful swelling of an inflamed retrocalcaneal bursa, sometimes combined with insertional tendinopathy of the Achilles tendon.

The term “pump bump” is often used to describe the condition because of pressure created by the rigid backs of pump-style shoes that aggravate the bony enlargement while walking.

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According to Vaishya et al., diagnosing Haglund’s syndrome involves examining patient history and clinical findings which may be supported by radiographic evaluation such as a magnetic resonance imaging scan. This can help in identifying posterosuperior calcaneal spurring with impingement on the Achilles tendon.

The authors also mention the detection of localised tenderness around the heel which can help in differentiating Haglund’s syndrome from other conditions with similar symptomatology such as isolated calcaneal bursitis, insertional Achilles tendinosis, plantar fasciitis and avulsion of the calcaneal tendon.

Agarwala et al. describe dorsiflexion at the ankle as increasing pressure on the retrocalcaneal bursa and the surrounding tissue which can cause chronic inflammation of these tissues. This can also occur in the absence of a significant calcaneal spur.

Treatment strategies need to primarily address pathological factors – resectioning of the posterosuperior calcaneal prominence and inflamed retrocalcaneal bursa in addition to debridement of the Achilles tendon and any associated spurs.

The authors list out conservative measures for Haglund’s syndrome as avoidance of uncomfortable footwear, a modification of activities, the use of cushions, pads for the heel and finally, stretching and strengthening of the gastrocnemius-soleus complex.

This can be implemented in conjunction with physical modalities such as extracorporeal shock wave therapy, ultrasound therapy and other deep heat modalities.

The American College of Foot and Ankle Surgeons lists out a high-arched foot structure as increasing an individual’s predisposition to Haglund’s deformity; this makes the inclusion of MASS4D® custom foot orthotics in the conservative phase of treatment ideal for the management of the condition.

Pes cavus is categorised as neuromuscular, congenital, idiopathic or traumatic; the idiopathic category is often classified separately from the congenital category.

An underlying neurologic abnormality is reportedly found in at least two-thirds of adults with a pes cavus foot; muscle imbalance typically exists in the form of strong peroneus longus and tibialis posterior muscles functioning alongside weak tibialis anterior and peroneous brevis muscles.

Although an idiopathic cavus foot (such as the subtle cavus deformity) does not have any underlying causes, it may be associated with ankle instability, varus ankle arthrosis, plantar fasciitis, metatarsalgia or claw toe deformity.

Traumatic causes of a pes cavus foot can include crash injuries, peroneal nerve damage, compartment syndrome and talar neck fracture malunion; the latter results in a fixed varus position of the subtalar, talonavicular and calcaneocuboid joints.

MASS4D® customised foot orthotics offer maximum reduction in local peak pressures by providing proper support to the foot to facilitate healthy distribution of weight, to increase the contact area across the plantar surface of the foot, to reduce excessive supination and to promote healthy pronation. 

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References:

1. Agarwala, S., Agrawal, P., Sobti, A. S. (2017) Surgical Management of Haglund’s Syndrome in Nonathletes: A Retrospective Review. The Journal of Foot and Ankle Surgery (Asia-Pacific): January/June 2017, Vol. 4, No. 1, pp. 19-22.
2. Vaishya, R., Agarwal, A. K., Azizi, A. T., Vijay, V. (2016) Haglund’s Syndrome: A Commonly Seen Mysterious Condition. Cureus: October 2016, Vol. 8, No. 10, e820. DOI 10.7759/cureus.820
3. Rosenbaum A. J., Lisella J., Patel N., Phillips N. (2014) The Cavus Foot. The Medical Clinics of North America: March 2014, DOI: 10.1016/j.mcna.2013.10.008
4. Kucuksen, S., Karahan, A. Y., Erol, K. (2012) Haglund Syndrome with Pump Bump. Medical Archives: December 2012, Vol. 66, No. 6, pp. 425-427. DOI: 10.5455/medarh.2012.66.425-427

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