Haglund’s Deformity

A Haglund’s deformity is a bony enlargement, or bump that our podiatrists regularly see and treat, that develops at the back of the calcaneus – your heel bone. 

The cause of Haglunds’ deformities are not fully understood by researchers, who are unsure exactly why they develop. The deformity often occurs spontaneously, and the bump can also cause the surrounding tissues to become irritated from rubbing against footwear, which is why we can suddenly develop symptoms when switching to a new pair of shoes. 

You’re more likely to develop a Haglund’s deformity if you are a runner, wear tight or poorly-fitting shoes, or if one of the joints close to your ankle called the subtalar joint is improperly aligned. 

The symptoms of a Haglund’s deformity can include a bump that varies in size, but the bony enlargement itself is actually asymptomatic and painless. If you do have symptoms, they’re actually coming from the surrounding structures, such as the Achilles tendon or the bursa at the back of the heel, which can become irritated from the way the bump causes them to be used, or from shoe straps rubbing against them. As such, you may experience:

• Pain at the back of the heel
• Inflammation
• Redness and warmth over the bony bump
• Callus may form over the bony bump with repeated rubbing and friction
• Pain from exercise, particularly where the Achilles tendon is engaged
• Pain when walking after rest
• Limping during walking

Can You Fix It?

Treating a Haglund’s deformity really means treating the damaged tissues at the back of the heel. Our podiatrists can diagnose a Haglund’s deformity from examining your feet, alongside your medical history. Medical imaging may be used to provide further clues about the cause of the pain – whether that is from an inflamed bursa, damage to the Achilles tendon at its insertion, or something else. 

As part of your care with us, our podiatrists will:

• Thoroughly examine your heels, going beyond noting the presence of the deformity to uncovering what is causing your painful symptoms
• Treat the damaged tissues at the back of the heel
• Prevent your symptoms from returning. This includes education so you know exactly what you should be doing and avoiding, including the best shoes for your feet. 

How Is A Haglund’s Deformity Treated? 

Your podiatrist will discuss the best treatment options for you following your assessment. We will consider the severity of your protrusion, your symptoms, your daily activities, and your goals. Your treatment may involve:

• Using ice and anti-inflammatories to help relieve your painful symptoms at home
• Using temporary heel lifts to reduce the strain on the tissues at the back of your heel, thereby reducing pain
• Going through your footwear with you – including helping you avoid footwear that is tight and rubs against the back of the heel, helping to prevent your symptoms from worsening
• Making shoe modifications to your existing footwear
• Using custom foot orthotics to help permanently reduce excess tension on the back of the heel by addressing identified biomechanical factors, and potentially adding a slight in-built heel raise if indicated
• An exercise program to stretch tight muscles like the Achilles tendon

Once the pain has gone, your podiatrist will then work with you to help set you up for success in the future and prevent your symptoms from returning. As experts in foot health, working with a podiatrist means that you stay supported every step along the way, to help you get the best outcomes for your foot health.

FAQs

How do I know if the bump on the back of my heel is a Haglund’s deformity or a different injury?

Interestingly, it’s common for a haglund’s deformity to occur alongside soft tissue problems like retrocalcaneal bursitis, calcaneal tendon bursitis, and thickening and inflammation of the calcaneal tendon. The combination of both the deformity and the soft tissue injuries is known as ‘haglund’s syndrome’. 

Soft tissue and tendon injuries on their own tend to come on quickly and bring with them characteristic symptoms like pain, swelling and redness. If the back of the heel is pressed upon, it may feel softer or more fluid-like. A haglund’s deformity, on the other hand, will feel quite firm to touch due to its bony nature. It is likely that you may have noticed the bony prominence for quite some time too, and at times without any painful symptoms.

Should I get an x-ray for a Haglund’s deformity?

An x-ray can help us better visualise what’s going on in the back of the heel, particularly if we suspect the involvement of multiple problems, like having a spur in the area. If tissue damage is suspected, an ultrasound may be used too. With this said, we don’t need any imaging to confirm whether or not you have a Haglund’s deformity – this can be done based on your symptoms paired with our clinical findings.

Will a Haglund’s deformity go away on its own?

No, Haglund’s deformities generally do not resolve on their own. Special care is needed to reduce the pressure on the back of the heel, treat any associated problems like tendinopathies, and then take the right steps to limit further pressure across the back of the heel. If you’ve got a painful Haglund’s deformity, or pain at the back of your heel, you should always see a podiatrist.

Why do some people get a Haglund’s deformity from wearing tight shoes and not others?

While it is well documented what happens when a Haglund’s deformity is present, the condition overall alongside its causative factors are actually poorly understood. 

Does ACC cover treating a Haglund’s deformity?

ACC covers accidental injuries in NZ, so it really depends on the cause of the pain at the back of your heel. If it is the result of an accident, you may be eligible. We can submit a claim form to ACC, it is up to them as to if your claim is approved.