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A Haglund’s deformity is a bony bump over the back of the heel, also known as retrocalcaneal exostosis. This enlargement of the bone is in the back of the heel where the Achilles tendon inserts. Haglund syndrome is when this bony bump causes pain in the overlying Achilles tendon or bursa.
When the area of enlarged bone rubs against that back of a shoe the soft tissue becomes irritated. This can cause pain in the bursa that is pressed between the Achilles tendon and the Haglund bump or the Achilles tendon itself.
Symptoms include a noticeable bump on the back of the heel, swelling, redness and inflamed tissue and pain over the back of the heel. Patients often describe pain when walking, especially after a period of rest, or when moving the foot up (dorsiflexion).
Diagnosis is based on detailed history, physical examination, and imaging. While the bony bump of a Haglund’s deformity predisposes patients to Haglund’s syndrome, this bony bump is not always painful. X-rays are useful in the diagnosis of Haglund’s syndrome. A diagnostic ultrasound or an magnetic resonance image (MRI) can rule out associated bursitis or Achilles tendon pathology.
Haglund’s syndrome is often treated conservatively by altering shoe wear, orthotics, physical therapy and anti-inflammatory drugs. Heel pads and wearing open heel shoes can decrease the irritation of the soft tissue over the back of the heel.
Tenex is a minimally invasive procedure that will remove the bony prominence against the Achilles tendon to help eliminate pain without the need for conventional surgery.
In cases that do not respond, surgery can remove the enlarged bone over the heel. Surgical treatments include retrocalcaneal decompression and calcaneal osteotomy to remove the bony bump.