Haglund's heel refers to an abnormal shape of the heel bone. Haglund's heel causes pain, pressure-related discomfort, and often inflammation of the bursa between the bone and the Achilles tendon. This anatomical abnormality creates a narrowing that can cause chronic irritation of the surrounding structures.
Below you will find more information on the causes, symptoms, diagnosis, treatment options, and selected specialists for Haglund’s heel.
Haglund's deformity is a bony change in the upper rear part of the heel. The altered shape of the heel bone causes increased pressure between the Achilles tendon, the bursa, and the bone. The resulting irritation can lead to bursitis/a>, swelling, redness, and heel spurs.
The most common causes of Haglund’s heel include foot deformities such as a high arch, unsuitable footwear—especially tight shoes—and high levels of athletic activity.
Diagnosis is made through clinical examination, X-rays, ultrasound, and MRI.
Treatment for Haglund’s heel typically begins with conservative therapy aimed at pain relief and reducing pressure on the affected area. If this is unsuccessful, surgery may be necessary.
In some people, the rear/upper part of the heel bone is more pointed and protrudes further than usual. This bony protrusion on the heel is called Haglund’s exostosis or simply exostosis. This creates a narrow passage between the bone and the Achilles tendon running behind it. As a result, the soft tissues are subjected to increased pressure and greater stress. The consequences are
The consequences include increased sensitivity, chronic irritation, swelling in the area of the Achilles tendon, and, in some cases, pronounced inflammation. The bursa located between the heel bone and the Achilles tendon—which acts as a shock absorber—is particularly often affected. If this tissue becomes inflamed, doctors refer to it as bursitis.
In Haglund’s heel, the heel bone is more pointed and protrudes further © rob3000 | AdobeStock
The Swedish orthopedic surgeon Patrik Haglund first described this condition in 1928. Often, the attachment of the Achilles tendon to the upper part of the heel bone is inflamed. There is also a bony protrusion at the attachment site, which alters the tension of the tendon against the heel bone.
This altered tension, combined with increased pressure from footwear, causes what is known as Haglund’s syndrome. It manifests as
This alters the tension on the tendon, which, together with pressure from the shoe, can contribute to the development of Haglund’s syndrome.
Haglund’s heel is a painful condition often referred to as a posterior or superior heel spur. This should be distinguished from an inferior heel spur, which is located on the sole of the foot.
The development of a Haglund heel can have various causes. In many cases, a Haglund heel is congenital, as the shape of the bone is genetically determined. Additionally, certain factors increase the risk of developing a Haglund heel.
Among the most common triggers are foot deformities such as a high arch or rearfoot deformities. Unsuitable footwear, especially tight shoes, can also contribute to its development. Added to this are repeated high levels of athletic stress that place constant strain on the Achilles tendon insertion.
The resulting pressure often leads to irritation of the Achilles tendon. This, in turn, leads to bursitis. Furthermore, the exostosis (bone spur) frequently affects the periosteum of the calcaneus and the area around the Achilles tendon.
If pressure and friction persist over a long period, all the soft tissues in the heel area can swell. This results in the typical visible bulge—or bone spur—that becomes palpable and visible to many affected individuals.
Haglund’s heel can occur on one or both sides. Where the heel bone rubs against the inside of the shoe, pressure pain and swelling occur.
At the onset of the condition, patients only feel pain during their first few steps (start-up pain). This pain subsides quickly.
Typical symptoms include pressure pain, redness, warmth, and heel pain in the heel area. In addition, the Achilles tendon may thicken. Many patients report increasing difficulty walking, running, or climbing stairs.
If this warning sign is ignored, the symptoms and inflammation often worsen. In the long term, those affected may no longer be able to walk or run normally.
As the condition progresses, the surrounding structures may become inflamed. An inflamed bursa often leads to significant swelling in the heel area. Symptoms occur both during activity and at rest.
Athletes are often affected by this condition. Women are slightly more likely to develop Haglund’s heel, while men generally experience symptoms less frequently. Studies also show that women may be affected by Haglund’s heel more often than men.
Doctors can usually recognize the presence of Haglund’s exostosis based on the symptoms described above. These symptoms typically occur both during physical activity and at rest.
A lateral X-ray reveals the bony spur. The assessment always takes into account the clinical symptoms and heel pain.
Doctors use an ultrasound examination to assess the condition of the Achilles tendon. They examine the tendon for thickening, which indicates the extent to which it is already involved in the pathological process of Haglund’s exostosis. This examination also reveals any bursitis or swelling of the bursa.
Haglund’s heel can also affect the Achilles tendon © bilderzwerg / Fotolia
A magnetic resonance imaging (MRI) scan with contrast dye is virtually indispensable for stage-specific diagnosis and treatment of Haglund’s heel. This allows for a precise examination of the affected soft tissues—namely, the Achilles tendon, bones, and bursae—and a detailed assessment of the specific stage of the condition. At the same time, the examination reveals calcium deposits in the Achilles tendon.
In principle, there are both surgical and conservative treatment options for Haglund’s heel. Surgical approaches focus on surgical procedures, while conservative approaches involve symptomatic local therapy, including pain medication. In most cases, conservative therapy can be attempted first, which is often successful. Surgical therapy is recommended at an early stage only if conservative treatment proves ineffective or if there are clear and progressive bony changes.
The goal is to relieve symptoms, reduce inflammation, and restore the foot’s ability to bear weight.
The most important orthopedic treatment goal is to relieve heel pain and restore the foot’s ability to bear weight during daily activities or sports.
To relieve pressure on the heel area as quickly as possible, it is recommended to wear loose-fitting shoes, ideally open-backed ones. Insoles that raise the heel by about one centimeter also relieve the painful pressure. They reduce the tension in the area of the Achilles tendon at the heel bone and the Achilles tendon insertion.
Runners should refrain from training until the pain subsides. To prevent a loss of endurance and strength, it is advisable to switch to aqua jogging and perform targeted strength training during the training break. Returning to running too soon can lead to chronic Achilles tendon problems and result in permanent limitations on running performance.
Pain relievers and anti-inflammatory medications such as ibuprofen and aspirin help reduce swelling and joint pain. In addition, various physical therapy techniques are available for the conservative treatment of Haglund’s heel. These include, for example,
For self-care, ice packs and cool quark wraps are recommended.
In particularly severe cases, complete immobilization of the foot in a cast or orthosis is necessary. This allows the ankle joint to be sufficiently relieved of stress and the inflammation to be stopped.
Conservative therapy often needs to be continued over a longer period of time until treatment is successful. Several months is typical.
If there is still no satisfactory improvement after six months, surgery is recommended.
Surgery is particularly necessary in cases of high training intensity. Athletes cannot permanently relieve pressure on their heel. Surgery is also advisable in cases where the constant pressure causes damage to the Achilles tendon.
The following procedures are available for treating Haglund’s heel:
The goal of the surgery is to remove the bony protrusion on the heel bone.
Removing the bony protrusion on the heel bone reduces the pressure of the heel against the inner edge of the shoe. This also relieves the
. Afterward, it is possible to wear shoes again without discomfort and to exercise while wearing them.
The procedure is usually performed under local anesthesia. However, general anesthesia is also available upon request. First, a three- to four-centimeter incision is made on the side of the Achilles tendon. The tendon is then held aside to expose the back of the heel bone and the bursa.
Next, portions of the bony protrusion are removed, typically using an oscillating saw. This specialized saw helps minimize damage to the Achilles tendon, bursa, and soft tissues. Finally, the site is sutured, and the joint is immobilized with a lower-leg cast.
The sutures are removed after about two weeks. Until the sutures are removed, it is absolutely essential to avoid putting any weight on the foot; this is why a lying cast is applied. Premature weight-bearing can jeopardize the success of the surgery.
If everything is normal at the follow-up examination, you will then be fitted with a walking cast, which allows you to gradually increase the weight-bearing on your foot.
For several years now, minimally invasive procedures have also been used for surgical treatment, in which special instruments are used to access the joint through small puncture incisions. Here, too, anesthesia of the leg is necessary; the principle of removing the bony protrusion and debriding the tissue is the same as in the open procedure described above.
If a foot deformity is the cause of Haglund’s heel, realignment of the heel bone is one of the most effective treatment approaches. Orthopedics offers various realignment surgeries for this purpose, which can be precisely tailored to each patient’s individual case.
For example, it is possible to correct a pes cavus deformity through a calcaneal osteotomy and effectively treat the resulting exostosis. An osteotomy involves cutting through the bone and reconnecting the bone ends in a different position. Immobilization is also necessary in this case. In addition, metal implants are used to stabilize the bone ends relative to one another, ensuring that the fragments remain in the correct position.
Following such a surgery, the foot must be off-loaded for at least six to eight weeks, during which time exercise is paused. Afterward, the patient begins a gradual return to weight-bearing on the foot and heel area.
The course of Haglund’s heel depends on the extent of the bony changes and the individual’s level of activity. If the condition is detected early, conservative measures can often lead to significant improvement.
If the underlying cause is not treated, symptoms may worsen. Repeated irritation can lead to chronic inflammation of the structures and an increase in the severity of the painful condition.
To prevent Haglund’s heel, one should ensure proper footwear, good foot alignment, or the use of orthopedic insoles.
Haglund’s deformity affects the upper rear portion of the heel bone. A classic heel spur is usually located on the sole of the foot. For this reason, Haglund’s deformity is often referred to as a posterior heel spur.
Complete bone resorption is rare. However, appropriate treatment options can significantly reduce symptoms.
Surgery is recommended if conservative treatments are not sufficiently effective or if the Achilles tendon is permanently damaged.
Yes, orthopedic insoles can reduce pressure and alleviate symptoms for many patients.
The most common symptoms include pressure pain, heel pain, redness, swelling, and pain in the area where the Achilles tendon attaches.
Treatment for Haglund’s heel includes conservative measures such as shoe modifications, physical therapy, shock wave therapy, and orthotic insoles. If symptoms persist, surgical intervention may be necessary.
