What is the treatment for Haglund deformity?

From the Guidelines

Treatment for Haglund deformity should begin with conservative measures, including wearing open-backed shoes, using heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss, as these methods have been shown to be effective in reducing symptoms and improving quality of life. According to 1, initial treatment options may include open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss. It is also important to note that local injections of corticosteroids are not recommended, as stated in 1.

Conservative Treatment

• Wearing open-backed shoes or soft heels to reduce pressure on the area
• Using heel pads or cushions to reduce pressure
• Applying ice to reduce inflammation
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and swelling
• Physical therapy exercises to stretch the Achilles tendon and strengthen surrounding muscles
• Custom orthotic devices to redistribute pressure away from the bony prominence

Surgical Intervention

If conservative treatments fail after 6-12 months, surgical intervention may be necessary, which typically involves removing the prominent bone and addressing any Achilles tendon damage, as implied by the need for referral to a podiatric foot and ankle surgeon if no improvement occurs, as stated in 1. Surgery requires several weeks of recovery with limited weight-bearing followed by physical therapy.

Additional Considerations

It is essential to address footwear and reduce pressure on the area, as Haglund deformity occurs when the bony enlargement at the back of the heel rubs against rigid shoe backs, causing inflammation of the bursa and surrounding tissues. Immobilization may be considered in particularly acute or refractory cases, as stated in 1.

From the Research

Treatment Options for Haglund Deformity

The treatment for Haglund deformity can be divided into conservative and surgical methods.

• Conservative treatment includes:
  • Altering the heel height in shoe wear 2
  • Orthosis 2
  • Physiotherapy 2
  • Anti-inflammatory drugs 2, 3
• Surgical treatment is considered in cases where conservative treatment fails, and may involve:
  • Resection of the posterosuperior calcaneal tubercle 4
  • Bursectomy 4
  • Excision of the Achilles tendon pathology 4
  • Reattachment of the Achilles tendon 4, 5
  • Gastrocnemius aponeurotic recession 4
  • Flexor hallucis longus transfer 4
  • Calcaneal osteotomy 6

Surgical Techniques and Outcomes

Surgical techniques for Haglund deformity have been developed to improve outcomes, including:

• Minimally invasive and endoscopic approaches 4
• Accurate measurement of bone removal using radiographic techniques 6
• Achievement of a specific osteotomy angle to decompress the retrocalcaneal bursa and remove the calcaneal step 6
• Studies have reported good outcomes with surgical treatment, including significant improvement in pain and function 5, 6