Haglund's disease: causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Jun 1, 2023

Haglund’s disease is also called Haglund’s syndrome or Haglund’s exostosis. These terms are used to refer to the same disease, which is characterised by a bone growth that causes considerable pain

The symptoms of Haglund’s disease begin precisely because of an outgrowth, which occurs at the attachment of the Achilles tendon.

Increasingly, this pathology is also linked to bursitis and can occur at any time, leading to various complications if neglected.

The pathology of Haglund’s disease can affect both feet simultaneously or only one

In addition, this disease can lead to severe pain, caused by the pressure of this growth in the Achilles tendon area.

This symptom thus makes it very complex to carry out daily activities such as walking, running, driving, creating considerable social and psychological discomfort.

Patients presenting the symptom of Haglund’s disease can be both children and adults, although usually the age of those most affected is between 30 and 55.

Patients suffering from this disease are therefore concentrated in this demographic group, which is equally divided into women and men.

Haglund’s disease in children

The symptoms of Haglund’s disease can also very often appear in children under the age of 14.

In this case, it is an inflammation at the level of the heel, particularly the heel, which can cause considerable discomfort and pain.

This disease in paediatric medicine is also referred to as Sever-Blanke-Haglund.

The symptoms of Haglund’s disease in children are not very different from those in adults.

Here too, the disease affects the growth core of the calcaneus, leading to considerable heel pain.

Children affected by this pathology are usually males in the 8-13 age group.

This pathology affects those who participate more in sports, such as football or basketball, but also overweight children.

Haglund’s disease in adults

The symptoms of Haglund’s disease in adults are not very different from those in children.

Again, the severe pain is caused by the alteration of the calcaneus, which leads to an excessive amount of bone.

Thus, even in adults, the first feature is exostosis.

Furthermore, in adults, the bone protuberance that leads to the limitation of everyday activities affects not only the Achilles tendon but also the retro-calcaneal bursa.

Often the protuberance can create a lot of discomfort between the bone and the shoe: the use of suitable footwear is in fact essential in this case to avoid complicating or further pain.

In adults, the alteration of the profile of the heel, with the slight deformity behind the foot, is even more noticeable.

Symptoms

When discussing the symptoms of Haglund’s disease, it must be specified that these can vary greatly depending on the severity of the disease.

Furthermore, the different symptoms can occur on one foot, on both feet at the same time or first on one foot and then on the other.

The symptoms of Haglund’s Syndrome are diverse, but the most common are determined by

a swelling of cartilage behind the foot, specifically in the heel area that usually rubs against the shoe
a strong pain in the heel that can prevent even simple movements such as walking or getting up from a seat;
a large swelling of the foot, specifically in the area affected by the disease, i.e. the Achilles tendon or a progressive malformation of this area of the foot.

In the first phase of this inflammation, the symptoms may appear more bearable and mild.

In fact, the pain typical of Haglund’s disease may present itself in a milder form in the early stages of the disease, for example with a slight pain in the Achilles tendon during sporting movements or simply when walking.

However, if these initial symptoms are underestimated, it is possible for the disease to reach advanced stages, characterised by severe pain, inflammation and swelling of the heel.

Causes

The excessive presence of bone is the main cause of Haglund’s disease.

In fact, it is the change in the normal anatomical profile of the heel caused by an excess of bone that later leads to symptoms such as severe pain in making any movement and difficulty in wearing shoes.

Bony alteration of the calcaneus is among the causes of Haglund’s disease in both adults and children: it leads to increased friction, particularly with soft tissue and the shoe.

Of course, practising sport regularly can also be considered one of the risk factors for Haglund’s Syndrome.

The reasons for this are simple: those who practise sport, particularly runners, with the wrong shoes can see a lot of foot and heel-related pathologies develop.

The use of shoes that are not cushioned, do not provide correct posture, and the presence of other pathologies, such as minor injuries, to the feet, are all factors that can lead to Haglund’s disease.

The type of shoe used every day can also lead to the appearance of the first symptoms, such as high heels, boots, safety shoes and skates.

Furthermore, the link between Haglund’s syndrome and other pathologies related to the conformation of the foot has also been proven.

In fact, by studying the anatomy of the feet of patients suffering from Haglund’s disease, it was discovered that many had hollow or flat feet.

Diagnosis

Usually, severe heel pain and slight deformity are two symptoms that make it easier to diagnose Haglund’s disease.

Posterior swelling of the foot combined with severe pain is in fact a clear sign of an exostosis-related problem.

Although the symptoms are clear, such as pain, difficulty wearing shoes and lameness, several tests may be necessary to diagnose Haglund’s disease.

These tests are in fact necessary to distinguish this syndrome with other conditions, such as bursitis, plantar fasciitis or tendinopathy.

A first step for diagnosis is to have a clear anamnesis, which can be carried out not only by a specialised professional but also by the family doctor.

Through a few simple questions, in fact, it is possible to investigate the symptoms communicated by the patient, but also factors that may influence this type of pain, such as recent intake of medication, any previous illnesses and diseases in the family.

Following a specialist examination by a specialised professional, it is possible to make a correct diagnosis of Haglund’s syndrome by excluding other pathologies, such as plantar fasciitis.

The main test to detect this inference is ultrasound.

Through this test, conditions such as bursitis or Achilles tendonitis can be specifically identified.

Instead, an X-ray may be required to check the health of the calcaneus.

From this test, the deformity and degree of prominence can be identified.

Finally, in more special cases, the patient may undergo an MRI scan, which is indicated in order to have a more precise and definitive diagnosis of the problem.

Prevention

The first step in preventing Haglund’s disease, especially for runners and sports enthusiasts, is to pay close attention to the choice of the most suitable shoes for practising sport, including walking.

Indeed, it is essential to opt for models that do not put pressure on the heel and at the same time provide proper support for motor activity.

The shoe size is also important, in order to avoid slipping between the heel and the shoe, which can lead to the formation of the malformation.

A size that is too tight would promote inflammation of the heel, leading to the appearance of the first symptoms of Haglund’s disease.

The choice of material is also important: it should not be too soft or too hard, in order to avoid rubbing at the heel and leading to unpleasant blisters as well as more complex symptoms.

The ground on which one trains is also of particular importance in preventing Haglund’s disease.

A ground that is too hard requires more effort, especially from the heel.

If it is not possible to change training locations, it is possible to opt for training socks with a reinforced heel area.

Treatments and physiotherapy

The remedies for Haglund’s disease are many and vary depending on the severity of the pathology and the stage the patient is at.

Certainly, the first step in preventing and treating this disease is the use of the correct shoes, capable of meeting the needs of the shape of the foot and the activities performed.

In the case of individuals who practise running, for example, it is essential to use a specific pair of shoes for this type of activity, in order to provide the heel with the correct support.

Before proceeding with a treatment for Haglund’s disease that is suitable for sportsmen and women, a rest period is necessary, with training being interrupted or slowed down depending on the severity of the syndrome.

For less severe cases, this condition can be resolved by pharmacological treatment, i.e. by taking anti-inflammatory drugs.

Often these solutions are then combined with local therapies, e.g. the use of customised insoles, capable of adapting to the different curves of the foot and providing the correct support for movement.

In intermediate cases, a series of sessions by professional physiotherapists can also be combined, either with a course of therapies to stimulate the body or with cycles of cortisone infiltrations.

In severe cases, the only remedy for Haglund’s disease is surgery

This operation is recommended in all those cases in which the pathology has become chronic and the pain in the heel unbearable.

This operation involves opening the tendon and removing the excess bone. This will remove the calcific neoformation and then anchor the tendon to the bone.

After the operation, it is the surgeon who arranges the patient’s rest period, which can range from a few days’ rest to a much longer stop from any activity.

The difference in the period of rest is due to the type of injury and the severity of Haglund’s disease.

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