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Ankle Pain

Haglund’s Deformity

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2 weeks ago

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by james

Anatomy

A Haglund’s Deformity is a bony protrusion that develops on the back of the heel bone (Calcaneus). It sits between the Calcaneus and the Achilles Tendon, and as this bone growth develops, it can begin to rub off the back of the Achilles Tendon, leading to pain and inflammation in the tendon and the back of the ankle bone.

Haglund's Deformity diagram

Symptoms of Haglund’s Deformity

Haglund’s Deformity can cause pain and swelling on the back of the ankle when walking or if there is pressure directly on the Haglund’s Deformity.

Patients report a burning and sharp sensation of pain that can be worse when walking uphill or running, while the most commonly observed symptom of Haglund’s Deformity is a pain when walking after rest.

A Haglund’s Deformity in isolation does not cause a typical pattern of stiffness in the morning that is associated with Achilles Tendonitis. Still, it is not uncommon to have both a Haglund’s Deformity and Achilles Tendonitis simultaneously.

Causes of Haglund’s Deformity

Historically the most common cause of a Haglund’s Deformity is from wearing tight-fitting shoes and was previously known as pump-bump from people wearing pumps.

There is some speculation that a tight Achilles Tendon can cause Haglund’s Deformity, but there is no concrete evidence to confirm this. There is a mild genetic link to developing Haglund’s Deformity. We speculate that wearing high heels or repeated friction on the back of the heel significantly contributes to its development.

Diagnosis of Haglund’s Deformity

A Physical Therapist or Sports Physical can quickly identify a Haglund’s Deformity from a clinical examination as it is associated with a large bump on the back of the heel bone alongside some swelling if it is particularly irritable.

Sometimes, a clinician may refer you for a scan to rule out other conditions, such as a calcaneus stress fracture. An x-ray is the easiest way to confirm the diagnosis, while an MRI may be requested to rule out any soft tissue involvement, such as an Insertional Achilles Tendonitis.

Home Treatment for Haglund’s Deformity

  • Icing for 10-15 minutes, 3-4 times daily
  • Take anti-inflammatories such as ibuprofen
  • Wear cushioned shoes with a heel raise
  • Rest from uphill and impact activity
  • Reduce step count as much as possible

Treatment of Haglund’s Deformity

Physical Therapy is the best form of treatment for Haglund’s Deformity. Following a Physical examination, muscular imbalances will be identified that may be exacerbating your symptoms. A Therapist can create a thorough rehabilitation programme of stretches, strengthening and stability exercises to improve your foot and ankle control. This is essential for pain relief and reducing the risk of further symptom deterioration.

Orthotics and insoles are effective treatment methods for Haglund’s Deformity. Depending on your foot position and control, an off-the-shelf insole may be sufficient, or a custom-made insole may be required.

A conversation with your Physical Therapist about footwear options is an essential aspect of treatment, and a clinician who regularly treats foot and ankle conditions should be able to provide numerous footwear options.

An injection can be a suitable alternative in cases that fail to settle with Physical Therapy. A corticosteroid injection that is ultrasound guided is effective in reducing inflammation and pain levels. Depending on the severity of your symptoms, a period of 1-2 weeks in a walker boot may be recommended before recommencing Physical Therapy.

Surgery may be recommended if you try 6 months of conservative treatment and symptoms continue to impact your quality of life. Surgery can be in the form of an osteotomy or Gastrocnemius lengthening.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

Related Article: Insertional Achilles Tendonitis 

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