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Haglund's heel is a well known condition. When, and why can surgery be recommended? Is there any literature or studies on this?

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Haglund's syndrome is defined as soft tissue and bony abnormalities in the retrocalcaneal region such as retrocalcaneal bursitis, superficial tendo Achilles bursitis, and thickening and/or inflammation of the Achilles tendon. Patients with Haglund's syndrome show a prominent bony contour of the posterior calcaneus.

Below an MRI showing typical Haglund's syndrome abnormalities (the white part just under the Achilis tendon and the bony projection of the calcaneus):

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Several studies have investigated the best management option for patients with Haglund's syndrome. The open access review by Sofka et al provides a good overview:

Here some facts regarding conservative treatment:

Conservative treatment options include reassessment of the footwear the patient is currently wearing, the use of heel inserts, and oral anti-inflammatory medication. The effects of heel elevation on the relationship between the calcaneal bursal projection and the Achilles tendon and retrocalcaenal bursa have been described. Although the size of the calcaneal bursal projection remains the same when the heel is elevated, the plantar calcaneal pitch angle decreases and shifts the osseous calcaneal bursal projection away from the retrocalcaneal soft tissues, decreasing friction and irritation

Here some facts regarding surgical treatment:

Surgical treatment options, including retrocalcaneal decompression and calcaneal ostectomy or osteotomy, have varying results. Inadequate bone resection can lead to recurrence of symptoms, with other postsurgical complications potentially including scar formation with nerve entrapment, weakening or rupture of the Achilles tendon, and nonunion of the calcaneal osteotomy.

Sources:

Sofka CM, Adler RS, Positano R, Pavlov H, Luchs JS. Haglund’s Syndrome: Diagnosis and Treatment Using Sonography. HSS Journal. 2006;2(1):27-29. doi:10.1007/s11420-005-0129-8.

http://radiopaedia.org/cases/haglund-syndrome-5 for the MRI image

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