Haglund's Syndrome and Insertional Achilles Tendinopathy

Abstract

Insertional Achilles tendinopathy (IAT) is a degenerative process at the insertion of the Achilles tendon onto the calcaneus. Many possible reasons for why this condition develops exist, and is likely due to a combination of factors, but an abnormal, bony prominence at the posterior-superior aspect of the calcaneus, known as a Haglund's deformity, may play a role in the development of IAT. This exostosis may cause increased compressive forces and irritation of the tendon at the calcaneal insertion, leading to pain and degenerative changes within the tendon. Non-operative treatments, including activity modification, eccentric exercise training, extracorporeal shock wave therapy, shoe wear modifications and orthotic inserts, and injection therapies, are the first line of treatment, but have shown varying levels of success in treating IAT. Operative treatments may be indicated after 3-6 months of failed non-operative treatment. In the case of IAT with Haglund's deformity, we describe the procedure of removing the exostosis, debriding the tendon, and reattaching the tendon to the calcaneus, with the use of the flexor hallucis longus tendon, when indicated. Return to sport timeline may be dependent upon severity of tendon damage pre-injury, but care should be taken to monitor load and pain management in a return to run progression program.