Haglund deformity is an enlargement of the upper back part of the heel bone near the Achilles tendon attachment. It forms a bump that rubs against the back of the shoe, causing irritation and inflammation of the skin.

If this persists, inflammation develops in deeper tissues, including the Achilles tendon bursae and the tendon itself.

Pain initially occurs when walking and, in advanced stages, also at rest. Physical activity becomes considerably restricted. When all these changes occur together, the condition is called Haglund syndrome. It most often affects middle-aged men and usually occurs on one side, though both sides may be affected.

Causes of Haglund deformity

The causes of the deformity are unknown, but risk factors favouring its development include:

  • intensive running
  • tight footwear
  • previous ankle injury
  • heel bone deformity, for example following trauma or present from birth
  • high-arched foot
  • excess weight
  • previous Achilles tendon injuries
  • gastrocnemius muscle contracture
  • a genetic predisposition has also been observed

Diagnosis of Haglund deformity

The foot is examined for a bump at the back of the heel and skin changes such as redness, swelling, calluses and abrasions. The distal Achilles tendon is often painful on palpation, and limping may develop. Diagnosis is confirmed using imaging: foot X-rays, standing PedCAT CT, and MRI or ultrasound.

Treatment of Haglund deformity

Initial non-surgical treatment includes:

  • modifying footwear to reduce rubbing at the back of the heel
  • modifying sporting activity, particularly running
  • anti-inflammatory medicines
  • physical treatments: cryotherapy, ultrasound, iontophoresis and laser therapy
  • stretching the posterior calf muscles and eccentric exercises
  • shockwave therapy
  • orthotic support, ranging from heel inserts to full rigid braces resembling a tall walking boot
  • local administration of platelet-rich plasma (PRP), hyaluronic acid and steroid medicines

If there is no improvement after six months of these treatments, surgery should be considered. The procedure is selected according to the severity of the condition. Surgical techniques include:

  • removal of the enlarged part of the heel bone
  • removal of inflamed Achilles tendon bursae
  • Achilles tendon debridement, sometimes requiring detachment from the heel bone and reconstruction
  • cutting the heel bone to reduce the deformity

Some procedures use minimally invasive techniques.

Rehabilitation after Haglund deformity surgery

After surgery, patients use a partial plaster cast without weight-bearing for six weeks. They then use a special brace for four to six weeks that allows loading of the operated foot. Rehabilitation begins at approximately four weeks, initially with passive exercises, then active exercises and physical treatments. Return to sport occurs at approximately five months. These periods may be shorter or longer depending on the procedure performed.