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ESWT for Haglund's ??

Posted by David G on 8/18/03 at 09:58 (127209)

I have retrocalcaneal bursitis onset by Haglund's deformity (pump bump). I run track and would like to know if others have used ESWT for this diagnosis. thanks

Re: ESWT for Haglund's ??

Ed Davis, DPM on 8/18/03 at 10:11 (127211)

David:

The Haglund's deformity itself will have minimal help from ESWT but if there is associated tendon pathology of the achilles, then ESWT will help.
It is important to have an accurate diagnosis to determine how much of the problem emanates from the Haglunds (the boney growth) and how much from a potential achilles problem.

Ed

Re: ESWT for Haglund's ??

Alex on 8/18/03 at 10:43 (127216)

I had a Haglund's deformity removed via complete detachment and reattachment. Now that I'm healed, honestly my Achilles feels exactly like it did before the surgery - i.e. I'm not really better and maybe a tiny bit worse (I am now 15 months post op). Would you recommend giving ESWT a shot - money isn't as much of an issue - so I know that Canada is an option to save bucks, but I'm more interested in expertise - especially expertise in my type of condition.. I really, really want to get back running, so do any of you have any experience with competitive runners?

If you do recommend ESWT, what protocol would you recommend?

Re: ESWT for Haglund's ??

Ed Davis, DPM on 8/18/03 at 12:32 (127230)

Alex:
ESWT may be an option although getting more complete information would be more helpful. What do you mean by 'complete detachment and reattachment?'
Ed

Re: ESWT for Haglund's ??

Alex on 8/18/03 at 13:53 (127236)

>What do you mean by 'complete detachment and reattachment?'

I apologize if I'm giving more detail than requested :)

I mean that my achilles was completely detached from my calcaneus. The doc thought that he could cut away the spur without completely detaching the achilles, but when he went in I guess that the spur was larger and more stuck in the achilles than he had thought. So my recovery time went from 4-6 weeks to 6 weeks in a cast and then another six weeks before major weight bearing. He said I could run at 3-4 months, but my leg definitely wasn't healed enough. I tried a bit at 6 months with moderate discomfort and loss of motion after the run... So I decided that cross training is better. I am able to do almost every activity except run without pain or loss of motion. I work on flexibility all the time and am also keeping up on massaging the achilles. I can dorsiflex a moderate amount, but not the full range that would be ideal for running. The non-surgical side also still has some pain, but the pain is more up in the tendon than at the insertion area. On the surgical side, the pain is more a general pain around the insertion area and up to about 3/4 inch above that. The non surgical side has direct pain (i.e. sharp pain) if rubbed after a run where the surgical side is a more dull less localized pain ... but the surgical side loses a lot of ROM after a run where the nonsurgical doesn't lose any ROM.

Although I have some biomechanical issue that must have helped cause my problems, I have been able to run a huge amounts of distance at a very competitive level for many years of my life, so I am hopeful I will be able to run again. Also, as I can do tons of other activities without pain, I have been able to come close maintaining a high fitness level.

Although my non surgical side has never stopped me from running, if I go the ESWT route, I'll probably inquire if it makes sense to hit both sides as if I heal the surgical side, I'm sure the nonsurgical will be causing more problems soon if left untreated.

BTW, I have tried every major and non major treatment for my achilles as the problem built over the last 5 years...

Re: ESWT for Haglund's ??

Ed Davis, DPM on 8/18/03 at 15:02 (127239)

Alex:
A Haglund's deformity is a boney enlargement of the top, back portion of the heel bone, above where the achilles attaches. As such, the achilles tendon is never detached in surgery for Haglund's.

Reasons to detach the achilles would include a spur at the back of the heel bone or retrocalcaneal calcific enthesopathy (occasionally this is confused with Haglund's deformity). Two determinants of the success of such procedure include: the strength of the attachment (we assume too much motion at the tendon bone interface was part of the original problem) and treatment of contribuatory biomechanical issues (excess side to side motion of the heel in gait and tight gastrosoleus achilles complex).
Ed

Re: ESWT for Haglund's ??

Alex on 8/18/03 at 15:13 (127240)

I'm in over my head on the terminology, but I believe that you've read it right - he may have thought it was Haglund's or something, but it turned out that it was spur at the back of the heel bone... I have it in a jar, so I know he took out something :)... Anyway, as biomechanical issues go, I don't have excessive side to side motion in my gait, but I do have a tight gastroc/soleus --- not to the point of equinus (?), but still a bit tighter than should be...

Anyway, do you think ESWT could help improve the quality of my achilles at this point or should I look forward to a life free of running shoes?

Re: ESWT for Haglund's ??

Ed Davis, DPM on 8/18/03 at 16:23 (127244)

Alex:
Are you wearing a good motion control running shoe and an orthotic?
Ed

Re: ESWT for Haglund's ??

Dr. Z on 8/18/03 at 20:25 (127261)

Alex,

It sounds like you have insertional achilles tendonitis. This is where the pain in located right where the tendon attaches to the back of the heel bone. If you sit for any lenght of time and then start to walk or run are you in pain.
I have been using high energy ESWT at the insertion since 1999. I have used it in patients that have had failed achilles tendon surgery also We use the dornier epos ultra for this problem.
Is there pain where you press the achilles tendon directly behind the heel bone?

Re: ESWT for Haglund's ??

dr ben pearl on 8/18/03 at 20:41 (127263)

I would be reluctant to treat the area you had the previous surgery on unless I felt more certain of the quality of the repair. The other side would be the one I would treat first and if it fared well would reevaluate the side with surgery.

DRBP

Re: ESWT for Haglund's ??

Alex on 8/19/03 at 08:25 (127284)

Yes and yes :)

Re: ESWT for Haglund's ??

David G on 8/19/03 at 08:29 (127285)

So, the worse would be that an ESWT would be ineffective for my Haglunds? No potential side-affects or negative outcomes?

Re: ESWT for Haglund's ??

Alex on 8/19/03 at 08:31 (127286)

There is significant pain at the attachment, but rather than the sharp pain up in the tendon on the right side (non surgical), it is a duller, wider pain throughout that insertion area of the heel. When searching about my problem I actually found someone who had their insertion area treated with ESWT. I was already slated for surgery, and was skeptical about ESWT because my orthopaedic surgeon slammed it, but the guy who had ESWT is 80-90% better where I am 0% better... I asked him where he had it done and strangely enough, I think you're the one who treated him (I'm guessing but his doctor's name began with Z and was from NJ)

Re: ESWT for Haglund's ??

Alex on 8/19/03 at 08:31 (127287)

Is there anything I can do to determine the quality of the repair?

Re: ESWT for Haglund's ??

john h on 8/19/03 at 09:38 (127291)

Dr. Z are you sure it was not Norm VanBrocklin?

Re: ESWT for Haglund's ??

Dr. Z on 8/19/03 at 12:10 (127302)

If it were Norm I could just call him and he would come to the phone and I wouldn't have to deal with some agent. I never saw Norm play only watched films of him

Re: ESWT for Haglund's ??

dr ben pearl on 8/21/03 at 22:29 (127608)

ultrasound or MRI would give some info on repair quality
DRBP

Re: ESWT for Haglund's ??

Ed Davis, DPM on 8/22/03 at 15:23 (127692)

Dr. Ben:
This is one area that I have had to re-do quite a few that were done elsewhere. It is not completely understood by some that the quality (strength) of the re-attachment has a lot to do with the outcome.
Ed