Haglund’s deformity: causes, treatment and more

Pain from a Haglund’s deformity can be debilitating. This disease is characterized by a lump on the back of the heel and pain, however the cause of this condition is not what you would expect.

Throughout this article we will break down the following topics:

What is Haglunds deformity?

 

What causes Haglunds deformity?

 

Clinical symptoms and treatment

 

Shoe advice for Haglunds deformity

 

Surgical managment

What is Haglund’s deformity?

Haglund's Deformity

Haglund’s deformity is a combination of several bony and soft tissue symptoms that combine to cause heel pain. The most notable symptom is a bump on the heel with associated pain.

The symptoms include a bony growth in the back of your heel – also known as a bone spur, combined with swelling of the bursae which is like a fluid filled sac. There is also associated tendinopathy in the insertion of the Achilles tendon.

Most studies suggest that Haglund’s is an impingement of the bony spur into the Achilles tendon. There is currently no proof that this does occur, and it would be equally likely that Achilles pain may develop first and as the tendon thickens it rubs on the bone.

Pain in the Achilles tendon can develop because of increased load on the tendon. For example insertional Achilles pain can occur from hiking when you haven’t hiked in a long time.

Can a Haglund’s deformity go away?

Many people have bony growths on the heel bone and are completely pain-free. Haglund’s deformity doesn’t mean that everyone with extra bone will develop or keep pain in the heel.

If the tendon and bursae can be settled, then there is a good chance that your heel pain can resolve.

There will be some cases that do require further surgical management. These cases require surgery because they don’t respond to conservative treatment alone.

Who is affected by Haglund’s deformity?

Haglund’s most commonly affects middle-aged people with women more likely to develop this condition than men. There is higher chance of developing Haglunds in people that are overweight.

It can be present in one heel. More commonly people will develop a Haglund’s deformity in both heels.

What causes Haglund’s deformity?

It was originally thought that rubbing of the back of the heel on hard shoes was the cause of this condition. The increased friction then caused increased bone growth which pinched the tendon.

The exact cause of this condition is unknown, however there are some factors that can contribute. These are:

               –over-practice in runners

               -tight or poorly fitting shoes

               -tight Achilles tendon

All of these contributing factors can be modified to reduce the risk of Haglund’s. Also in treatment these causes are what is targeted first to reduce pain.

Clinical symptoms for Haglund’s syndrome

Most people will experience heel pain and a notable bump or lump on the heel. This is different from the lump you will see on an Achilles tendon when there is Achilles mid-substance tendinopathy.

Patients will have pain with pressure on the heel in certain shoes. Pain may also be present with walking and can cause a limp. There will also be increase pain with first walking after sitting for a period.

You may also notice heel pain in the morning as you first get out of bed.

Treatment for Haglund’s Deformity

Treatment for Haglund’s Deformity usually starts with conservative management. There is a few different options that can be explored with your physiotherapist. These include:

                –Heel lifts

                -Trialling different shoes

                -Padding around the heel

                -A trial of different orthotics

                -Ice may be initially helpful

                –Gentle exercises to relieve pressure

Shoes for Haglund’s deformity

Shoes are very important with managing Haglund’s Syndrome. The aim is to reduce pressure at the back of the heel so that the heel is not irritated.

With this is mind open backed shoes are ideal! Looking for open backed shoes with arch support is helpful as this will help reduce strain.

Shoe brands we have recommended for similar conditions are crocs, birkenstocks or oofos. You can find further descriptions of these products in our plantar fasciitis and achilles tendonitis articles.

Surgical consideration

Surgery is worth considering if conservative management has been trialled diligently with minimal success for 6 months or more.

It is not a starting point as there are complications and the success rates are not 100%. In fact the success rate of open surgeries are about 76%.

However, if you have been living with pain for some time, this may be an option which can offer some pain relief.

The surgeon will talk about possible surgical options – depending on the MRI they may consider doing either an open or a keyhole surgery. In certain cases, they may need to cut away some of the unhealthy Achilles tendon.

Haglund's deformity surgery

Surgical complications

Surgical complications are more common in open procedures with one study stating the complication rate was around 40%. Keyhole surgeries have mildly less complications, but this is still worth considering before opting for surgery.

Complications include:

               -infection

               -Achilles tendon rupture

               -persistent heel pain

               -scar irritation

Recovery post-surgery

Recovery from Haglund’s surgery will vary depending on what surgery was required at the time. The orders will be different for an Achilles repair compared to a small chipping away of the heel bone

In general expect to be in an immobilisation boot for a number of weeks. This will be followed by a time of slowly coming out of the boot.

After this time you will begin gentle calf raise exercises and small stretches.

The physiotherapist will increase you exercise complexity as the tendon and heel bone gets stronger.

Conclusion

Haglund’s deformity is a combination of soft tissue damage of the Achilles tendon/bursae, as well as bony impingement due to a spur on the heel.

This condition results in heel pain and a bump on the heel. Surgery is not be needed in the majority of cases. Treatment such as changing shoes, heel lifts and physiotherapy exercises can help.

In some cases surgery may be required and this has its risks versus benefits. It may result in other complications however for some patients the risk may be justified.

What is the best treatment for Haglund's Deformity?

It is best to start treatment with conservative measures like physiotherapy. They will try things like exercises, heel lifts and changing shoes. If all of this fails, surgery is another option.

Can Haglund's deformity go away?

Haglund's deformity or syndrome is pain due to bony and soft tissue factors. Yes, the pain from this condition can go away when you address the soft tissue factors, even if you still have a bony spur. Occasionally this spur will need to be removed for symptoms to improve.

What surgery is required for Halgund's Deformity?

This depends on what your imaging results show. Some people will get away with a simple bone scraping, for others the Achilles tendon will also need to be repaired.

References

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Grambart ST, Lechner J, Wentz J. Differentiating Achilles Insertional Calcific Tendinosis and Haglund’s Deformity. Clin Podiatr Med Surg. 2021 Apr;38(2):165-181. doi: 10.1016/j.cpm.2020.12.003. Epub 2021 Feb 13. PMID: 33745649.

Lui TH, Lo CY, Siu YC. Minimally Invasive and Endoscopic Treatment of Haglund Syndrome. Foot Ankle Clin. 2019 Sep;24(3):515-531. doi: 10.1016/j.fcl.2019.04.006. Epub 2019 May 18. PMID: 31371001.

Paavola M, Orava S, Leppilahti J et al (2000) Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med 28(1):77–82 https://doi.org/10.1177/03635465000280012501

Sofka CM, Adler RS, Positano R, Pavlov H, Luchs JS. Haglund’s syndrome: diagnosis and treatment using sonography. HSS J. 2006;2(1):27-29. doi:10.1007/s11420-005-0129-8

Sundararajan PP, Wilde TS. Radiographic, clinical, and magnetic resonance imaging analysis of insertional Achilles tendinopathy. J Foot Ankle Surg. 2014 Mar-Apr;53(2):147-51. doi: 10.1053/j.jfas.2013.12.009. PMID: 24556480.

Vaishya R, Agarwal AK, Azizi AT, Vijay V. Haglund’s Syndrome: A Commonly Seen Mysterious Condition. Cureus. 2016;8(10):e820. Published 2016 Oct 7. doi:10.7759/cureus.820