This type of deformity looks like an enlargement of the bone (the bone is called calcaneus) just above and behind the heel. There is no swelling at the site, only pain and/or soreness. If a person wears shoes with a tight heel counter (the part of the shoe around the heel), then they aggravate it so wearing sandals is more comfortable.
Haglund’s deformity is caused by an inflexible heel counter that is often present in ice skates and high-heeled shoes. This is when the bony prominence (exostosis) begins to develop; soreness develops only later.
This type of deformity can lead to retrocalcaneal bursitis (inflammation of the bursa behind the calcaneus). Furthermore, the prominence itself leads to more bursitis by irritating it. In fact, Haglund’s deformity is often misdiagnosed as retrocalcaneal bursitis. While both conditions have the symptoms of irritation, redness, and enlargement at or near the base of Achilles tendon, Haglund’s deformity is painful only when pressed and has redness and swelling that does not spread further than the prominence itself.
X-ray images help to diagnose Haglund’s deformity and MRI can show its outline.
To help with the pain upon pressure and reduce the strain on Achilles tendon, one can wear shoes without heels or with stretched, cushioned or softer heel counters. Also, the heels of the shoes can be modified with a 6 mm heel-raise, which can be done by a certified pedorthist.
The common treatment is PRICEMM: Protection, relative Rest, Ice, Compression, Elevation, Medication, and rehabilitation exercise Modalities. It’s also useful to complete an eccentric strengthening program and perform soleus and gastrocnemius stretching. If this treatment has not helped, after 6 months surgery may be recommended.