Haglund's Syndrome: Disappointing Results Following Surgery-A Clinical And Radiographic Analysis

Clinical and radiographic data were analyzed for 49 sur-gical interventions of painful heel syndrome with a mean follow-up of 4 years and 7 months. In all patients the sur-gical procedure consisted of a triangular shaped resec-tion of the posterosuperior portion of the calcaneus. The clinical evaluation showed disappointing results with complete relief of complaints in only 34 procedures (69.4%), and 7 patients (14.3%) with even a worsening of their symptoms. The time course of rehabilitation was long with an average of 6 months of functionally signifi-cant pain after surgery, reducing the willingness to under-go this operation again. Formerly published angular thresholds of radiographic calcaneal angles could not be confirmed to be predictors for the preoperative symp-toms or the postoperative outcome. There was no accu-mulation of pathologic clinical foot shapes, only a slight increased calcaneal pitch in patients with isolated pain on the posterosuperior lateral part of the calcaneus. According to Haglund's description of painful heel syn-drome, the clinical picture of our patients included affec-tions of bone, tendon, peritendon, bursae, soft tissue and skin in different combinations. Based on this evaluation, we advise to be cautious to indicate the operation. All possibilities of conservative treatment should be performed prior to surgery