Haglund syndrome
| Classification according to ICD-10 | |
|---|---|
| M92.6 | Juvenile osteochondrosis of the tarsus - juvenile osteochondrosis of the os tibiale externum (Haglund's disease) |
| M77.3 | Calcaneus spur |
| ICD-10 online (WHO version 2019) | |
The Haglund's deformity called a heel pain and is named after the Swedish orthopedic surgeon Patrik Haglund named. However, there are two different clinical pictures with this name, which are often mixed up, but are fundamentally different:
- The disease Sever-Haglund is an alternative name for the heel pain in children, by a Verknöcherungsstörung at the heel Apophyse is triggered during growth.
- The Haglund exostosis is a widening of a bony outgrowth or at the rear upper Fersenbeineck the region of the Achilles tendon approach, which may cause pain in adults.
Sever-Haglund's disease in children
The ossification disorder of the calcaneus apophysis can only occur in children and is caused by excessive pulling of the strong Achilles tendon on the still relatively soft apophysis in the growing bone. The calcaneus apophysis cannot be supplied with blood directly intraosseously due to the still open growth plate, and the extraosseous blood supply is also critical at the heel. In addition, with increasing growth there is an increasing lever arm, which further increases the force of the calf muscles.
Typically, heel pain occurs in children between 11 and 13 years of age who have very high running and jumping performances, e.g. B. in football, basketball or athletics. Boys are more likely to be affected. Haglund's disease can occur on both sides, but is usually first found on the dominant foot. If the pain is severe, the child has to give up sport, sometimes limping.
diagnosis
The diagnosis can be made clinically by the typical pressure pain on the apophysis from the dorsal and plantar sides, often there is also pain on the opposite side. The Achilles tendon is more often shortened. A heel gait (heel gait) is usually not possible on the painful side, and sometimes the child cannot hop on one leg on the affected side, while the Achilles tendon and the tendon attachment are painless.
A lateral x-ray of the heel often shows dissolution of the apophysis, which has multiple patchy islands of condensation. However, this often also affects the non-painful opposite side and is also found in children without pain (when x-rays are taken, e.g. after an accident), so that x-rays are not sensitive and therefore not helpful.
In the delimitation, traumatic injuries, which are very rare in childhood and require a corresponding accident mechanism, must be excluded, and benign calcaneal cysts occasionally show up on X-rays, which are usually not symptomatic. Tendon problems do not occur in children under 14 years of age as well as an anterior " heel spur ".
therapy
If the pain is too strong, you must first take a break from exercising. B. necessary on two forearm crutches . Temporary immobilization in a lower leg cast is extremely rarely necessary. After a break in sport lasting several weeks, the return to work must be slowly building up, initially avoiding overly intensive jumping training.
Local non-steroidal anti-inflammatory drugs such as diclofenac can be helpful when applied from behind as an ointment or patch, and also as an oral weight-adapted medication for severe pain after exercise. B. ibuprofen .
Since there is often pain under the heel, it makes sense either to prescribe heel wedges (on both sides) or to recommend shoes that have a particularly soft and thick sole, and thus cushion the peak load when the heel strikes. Insoles are not helpful (if there is no other foot misalignment). Physiotherapy with stretching exercises for the Achilles tendon can be useful if it is shortened. Other procedures are irrelevant for Haglund's disease. Surgical procedures also have a high risk of damaging the growth plate.
Haglund's disease is self-limiting and disappears without long-term consequences as soon as the growth plate is closed and the bones are stable enough, which is the case (without growth disruption) at the latest at fourteen. Until then, however, pain of varying degrees can recur after the acute phase, which in rare cases force a one to one and a half year sports break. Often times, however, the child can learn to assess the limits of stress and then to take a break before the pain becomes too severe again.
Haglund exostosis in adults
This heel pain only affects adults and the pain is located at the back of the heel and in the area of the Achilles tendon attachment , but not under the heel (whereas plantar fasciitis can occur as anterior heel pain).
Since the calcaneus forms a bony nose or extension at its rear upper corner, Haglund's exostosis is often referred to as the posterior heel spur .
However, in his original description, Patrik Haglund described a bone nose (exostosis) in front of (ventral) the Achilles tendon, which can lead to a conflict with the Achilles tendon and an Achilles tendonitis , while in the meantime often a posterior extension or angular formation of the upper posterior corner of the heel bone as Haglund -Exostosis can be called, which can conflict with the footwear and provoke a bursitis ( bursitis achillea ).
diagnosis
The diagnosis can be confirmed by a lateral x-ray of the calcaneus after the corresponding examination findings with localized pain and pain when pulling on the Achilles tendon (that of the "anterior" exostosis). In the case of bursitis or tendinitis, an ultrasound examination can be useful, and both are clearly visible in magnetic resonance imaging .
therapy
In the case of bursitis, pressure relief by changing or replacing the footwear is particularly useful. One possibility are shoes without a rear edge (toe), but ankle-high shoes can also be useful if they are constructed a little differently to relieve pressure than low shoes, the edge of which is often bothersome.
In the case of tendinitis caused by the heel spur, conservative therapy such as that for Achilles tendonitis may initially be helpful, including physiotherapy v. a. with stretching exercises for the Achilles tendon, relieving insoles, shock wave therapy , local or oral non-steroidal anti-inflammatory drugs and cortisone infiltration .
Surgical removal of the exostosis is another option , but the resulting scar tissue can also be sensitive to pressure.
