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Haglund heel - retrocalcanear bursitis

Haglund heel (retrocalcanear bursitis) deformation is a relatively common state, resulting in swelling of soft tissue on the back side of the heel bone and/or creation of bone bulge on the vertex of Achilles tendon and heel bone. Also known as retrocalcanear bursitis, this most often affects adolescent girls, and is connected to wearing high heels. It is also common with athletes who prefer hard training shoes.

Usually, the upper part of the heel bone (calcaneus) is round. But in some people it is a little more angular. If those people wear hard shoes with sharp heel part (leather straps), a pain typical for Haglund's heel can develop itself. All of this maximizes by wearing high heels. More friction can cause bursitis (inflammation of the fluid sack which normally reduces the friction between Achilles tendon and the heel bone) and in the end it causes a painful swelling of soft tissue and hardening of the skin above it.

Patients with Haglund's deformation usually complain about pain and swelling connected to bone bulge or accompanying bursitis. Because of the friction, there can be a change in skin colour. Even with people who have no symptoms, change in the way of walking can suggest a problem in the back part of the heel bone.

Treating this condition almost always starts with ice compresses that should reduce inflammation, and changing the shoes, which should be soft and with no hard or inelastic parts in the area of heel bone. Soft insertions under the heel can help with pain. Next step involves physical therapy, especially laser and ultrasound, and pulse magnetic field therapy. Flexibility exercises for Achilles tendon and foot muscles should be performed in this stage. A flexible tendon is usually less painful. With athletes, one should examine the technique of running and jumping, along with choosing best possible shoes for a certain sport. Sports orthopedic insoles are a helpful device in treating these conditions. Other than changing the path of the force, they can additionally reduce the stress of the place where the inflammation is the strongest.  

If intensive and long physical therapy produces no significant improvement, then in cooperation with the orthopedist a possibility of shock wave therapy can be discussed. Since the root of the problem is creation of bone bulge, the goal is to reduce irritation of soft tissue around it. This method cannot „break“ the bulge, even though in some cases it can be minimized and reduced.

When all standard methods are tried out and there is no significant improvement, surgery must be considered. It can be minimal – performed only on soft tissue. In this case the recovery is relatively quick. But with greater bone bulges surgery consists of removing the parts of bone bulge and possibly even transferring the vertex of Achilles tendon. Recovery is long, even up to six months.

Haglund's syndrome can be connected with the Achilles tendon capsule inflammation, and longer limping can cause many painful conditions on the foot, shin, knee, and even hip. Because of all this, help should be sought immediately after first symptoms – pain and swelling. Some irritations and pain go away by itself, but some can evolve in a chronic problem (especially in athletes).

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