Achilles Hagglunds Deformity and Insertional Tendonosis
What Is a Hagglunds Deformity?
A Hagglunds deformity is a prominence of the heel bone (calcaneum) into which the Achilles tendon inserts. This characteristically is prominent postero-laterally and leads to a visible bump at back and outer aspect of the heel. A Hagglunds deformity produces local pain and irritation from the counter of the shoe. When out of a shoe or in shoe wear without a counter, a Hagglunds deformity generally is comfortable. The problem is one of a normal variation in the local anatomy. The bone underlying the tendon is of normal type and quality as is the overlying tendon. It is the prominence of the bone which causes the tendon to rub and produces the symptoms.
What Is Insertional Tendonosis of the Achilles?
Insertional tendonosis of the Achilles tendon refers to degenerative changes which occur at the point where the Achilles inserts at the back of the heel bone (calcaneum). The Achilles tendon has an extensive insertion into the back part of the calcaneum and degenerative change within the Achilles tendon can affect small areas or large areas of this insertion.
Degenerative change at this part of the Achilles tendon is generally not associated with changes in the body of the rest of the Achilles tendon. If longstanding and severe then bone can be deposited within the insertion of the Achilles tendon(1).
Treatment for Hagglunds Deformity/Or Insertional Achilles Tendonosis
The treatment options both operative and non-operative for both of these conditions are the same.
Non-Operative Treatment of Hagglunds Deformity, Achilles Tendonosis
A non-operative route is not often successful. This simply involves ensuring shoes do not impinge upon the tendon or bony lump in the main. Shoe wear needs to be chosen with this in mind and occasionally the heel can be re-positioned with a re-supporting orthotic. The latter really only helps with a flat foot which also has an insertional problem.
Operative Management of Hagglunds Deformity and Insertional Achilles Tendonosis
Often management requires a direct removal of the postero-lateral bony prominence in a Hagglunds deformity and a debridement of the tendon insertion if insertional Achilles tendonosis is present. If there is calcification within the Achilles insertion in the latter cases will also need to be removed under direct vision. In both the Hagglunds deformity and also isolated insertional Achilles tendonosis the Achilles tendon will require to be partially freed from its insertion into the back of the calcaneum. Once this is done the tendon will need to be reattached to the back part of the calcaneum and this is generally done using a bio-absorbable anchor.
After surgery the Achilles tendon needs a chance to stick back down on to the heel bone. The repair of the Achilles tendon is therefore protected with a plaster cast for a total of six weeks. It may be necessary to non-weight bear for the majority or even all of this time, dependent upon how much of the Achilles tendon has had to be released and reattached.
Operative Gallery For Hagglunds Deformity
To view a surgeon’s operative manual, go to The Foot Surgery Atlas
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