Haglund’s and Retrocalcaneal Bursitis

What is Haglund’s Syndrome and Retrocalcaneal Bursitis?

Haglund’s prominence is a bony enlargement on the back of the outer heel. 

The retrocalcaneal bursa is a fluid-filled sac located at the back of the heel under the Achilles tendon. It contains lubricating fluid that reduces friction between the tendon and bone (see image and Achilles & Heel - Anatomy and Imaging). 

When this prominence rubs against shoes or the Achilles, the bursa and tendon become irritated. This often leads to painful inflammation (Achilles tendinitis and retrocalcaneal bursitis), and this is called Haglund's syndrome.

Interesting fact: some people call this condition "cucumber heel" - I don't know why.

Cause of Haglund's Syndrome and Bursitis

Haglund’s prominence is common and often present from childhood. 

It becomes symptomatic when rubbing occurs due to rigid backed shoes or increased activity.

Symptoms of Haglund's Syndrome & Bursitis

The most common symptoms are:
  • pain and tenderness at the back of the heel, especially while walking or running. 
  • a noticeable bump on the back of the heel
  • the skin on the back of the heel may become warm and red. 

Diagnosis of Haglund's Syndrome and Bursitis

The diagnosis is usually easy to make based on:
  • history
  • physical examination of the Achilles and heel. 
The other Achilles condition that needs to be ruled out is Achilles tendinopathy, both non-insertional and insertional versions.

Diagnostic tests such as X-ray (see image above), ultrasound and/or MRI may be required if non-operative treatment does not improve symptoms.

Treatment of Haglund's Syndrome and Bursitis

Non-surgical treatment

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony prominence. 

Non-surgical treatment  includes one or more of the following:
  • ice
  • stretching exercises
  • avoiding running on hard surfaces and uphill
  • heel lifts
  • backless or soft backed shoes
  • oral and/or topical anti-inflammatory medications (ibuprofen and voltarin, etc)
  • physiotherapy
  • cortisone injections into the bursa
Please see Non-surgical Treatment in the TREATMENTS menu for more information.

Surgical Treatment

Surgery is considered when non-surgical treatments fail to resolve pain and inflammation.

It involves removal of the Haglund's prominence and retrocalcaneal bursa. This is a day surgery procedure and can be done either by "keyhole" or mini-open methods. Both require a bandage and crutches for two weeks but no "moon-boot" or cast. 

Please see Haglund's and Bursa Removal in the ACHILLES & HEEL menu for more information. 
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