Haglund Deformity

What Is A Haglund Deformity & How Can Physio Help?

A Haglund deformity, is a bony enlargement at the back of the heel. This condition can cause discomfort, irritation, and pain, especially when wearing certain types of footwear. In some circumstances, a Haglund deformity can significantly impact mobility and quality of life.

What Is A Haglund Deformity?

A Haglund deformity is a bony prominence that develops on the upper part of the calcaneus (heel bone), where the Achilles tendon attaches. The condition can become painful when repeated friction, or pressure irritates the soft tissues around this area. Often resulting from ill-fitting footwear and activity overload. Irritation may lead to inflammation of the retrocalcaneal bursa (a fluid-filled sac that cushions the tendon), a condition known as bursitis. Both Haglund deformity, and retrocalcaneal bursitis can significantly limit an individuals function. Causing pain and markedly reduced activity capacity, similar to that associated with achilles tendinopathy.

Potential Causes

Several factors can contribute to the development of a painful Haglund deformity:

• Foot Shape: A high-arched foot may increase pressure on the heel, contributing to irritation and is considered to be a potential risk factor associated with the condition.
• Tight Footwear : Shoes with a rigid unforgiving heel counter, such heels and dress shoes, can exacerbate the problem. Through increasing local friction and pressure to the bony prominence.
• Overloading : Repetitive activities including running or hiking may contribute to persistent irritation, triggering a painful episode.

Symptoms Of Painful Haglund Deformity

Common signs and symptoms of a Haglund deformity include:

• Pain and tenderness at the back of the heel.
• Swelling and redness around the affected area. Including a visual and palpable bony prominence either on the inside, or outside of the heel bone (or both).
• Difficulty wearing certain shoes due to discomfort. Often having a preference for barefoot, or wearing open back slides.

How Can Physiotherapy Assist?

Physiotherapy offers effective non-invasive treatment options for managing pain associated with Haglund deformities. A tailored physiotherapy program focuses on reducing symptoms, improving function, and preventing recurrence. A physiotherapist will evaluate your loading behaviours, foot biomechanics, posture, and footwear to identify contributing factors. Understanding the root cause behind the pain flare up is essential for designing an effective treatment plan.

Treatment approaches are varied, including:

• Pain Management: In clinic treatment options may include simple things like ice therapy, use of topical creams, manual therapy to the foot and lower leg, laser therapy, shockwave therapy to name a few…
• Appropriate Loading Exercises: Specific exercises to address the calf -achilles complex are commonly prescribed. This may include working to loosen/release tight calf muscles, progressive calf loading to appropriately stress the achilles tendon. As well as intrinsic foot strengthening exercises.
• Movement Training: Addressing relevant movement patterns, including appropriate footwear prescription to minimize heel irritation during daily activities.
• Taping Techniques: Taping, heel pads, heel lifts and orthotic prescription can assist in redistributing pressure away from the painful prominence. Potentially providing relief and preventing further irritation. Allowing the pain to settle.

Tips for Managing An Uncomfortable Haglund Deformity

• Choose the Right Footwear: Typically addressing footwear is essential in managing heel pain. The simplistic approach is to look for shoes with soft, cushioned heel counters. This reduces friction and pressure to the bony enlargements.
• Avoid High-Impact Activities: When having a painful episode, if running, or jumping actions worsens symptoms, consider switching to low-impact exercises. Swimming is often very well tolerated as it doesn’t require shoes, or ground contact and typically will not irritate heel pain.

When to Consider More Invasive Treatment Options

While physiotherapy is effective in managing heel pain for many individuals. Severe cases of Haglund deformity related pain may require more invasive options if conservative management doesn’t offer appropriate relief. This may include a local cortisone injection, or surgery. Surgery will typically involve removing the bony prominence and debriding any associated soft tissue changes deemed appropriate. However, as in most circumstances this is very much a last resort after all non-invasive treatments have been exhausted.

And although a Haglund deformity can be painful and disruptive. Effective conservative treatments are available. Physiotherapy and Podiatry play an important role in managing heel pain of this nature. By providing pain relief, activity guidance, targeted exercises and lifestyle modifications addressing triggers. Helping regain your active lifestyle and prevent future flare-ups.

If you’re struggling with heel pain, don’t wait—seek physiotherapy guidance today.