Conservative treatment options for Haglund's deformity
The term Haglund's deformity (also called Haglund's disease) describes a bump of bone (exostosis) found on the posterior, lateral aspect of the heel. Haglund's deformity is usually found bilaterally and varies in size. The origin of a Haglund's deformity is debated in the literature. Most authors believe that a Haglund's deformity forms as a reaction from external pressure. External pressure may include stiff shoes, such as the heel counter on a hockey skate or stiff shoe.
It's important to differentiate Haglund's deformity from insertional Achilles tendonitis. Haglund's is found at the lateral margin of the Achilles tendon and only hurts with direct shoe pressure. Insertional Achilles tendinitis, on the other hand, shows hypertrophy (bone growth and swelling) encompassing the entire body of the Achilles tendon where it inserts into the heel bone. Achilles tendinitis hurts at the onset of activity such as getting out of bed with your first steps in the morning, or at the onset of a run.
Once you've determined that the problem is Haglund's disease and not insertional Achilles tendinitis, there's several opportunities for conservative treatment. Treatment options include;
By the time I see a patient in the office with a Haglund's deformity, most have already tried an open heel shoe like a sandal or clog. Although open shoes are not a very good winter time solution, open heel shoes are definitely a starting point for all patients with Haglund's deformity.
A simple heel lift can be an effective tool if the primary force applied to the Haglund's bump is at the level of the shoe counter. By using a heel lift, you can raise the bump above the level of the heel counter. It's a simple solution and sometimes very effective.
A split tongue pad is another simple solution used to off-load direct pressure from the Haglund's bump. A split tongue pad is shaped using scissors and placed within the heel counter of the shoe adjacent to the pressure point of the Haglund's bump.
The Achilles Heel Pad is a simple gel lined sock that helps to off-load pressure on the posterior heel.
Be sure to read our knowledge base article on Haglund's disease for complete information on both conservative and surgical methods of care.