Haglund's syndrome: disappointing results following surgery -- a clinical and radiographic analysis.

Clinical and radiographic data were analyzed for 49 surgical interventions of painful heel syndrome with a mean follow-up of 4 years and 7 months. In all patients the surgical procedure consisted of a triangular shaped resection 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 significant pain after surgery, reducing the willingness to undergo this operation again. Formerly published angular thresholds of radiographic calcaneal angles could not be confirmed to be predictors for the preoperative symptoms or the postoperative outcome. There was no accumulation 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 syndrome, the clinical picture of our patients included affections 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.