The Haglund's heel is divided into different types and degrees of severity:

1. Asymptomatic Haglund's heel:
   • Bony protrusion without discomfort.
2. Symptomatic Haglund's heel:
   • With pain and inflammation in the area of the Achilles tendon and the bursa (retrocalcaneal bursitis).
3. Chronic Haglund's heel:
   • Long-term discomfort with progressive thickening of the Achilles tendon and degenerative changes.

The Haglund's deformity arises from a combination of genetic and external factors:

• Congenital factors:
  • A high arch (cavus foot) or a shortened Achilles tendon increase pressure on the heel and promote the formation of the bony protrusion.
• Mechanical stress:
  • Repeated friction and pressure from tight or poorly fitting shoes, especially shoes with a hard heel counter.
• Sports activities:
  • Strenuous sports such as running or jumping promote microtrauma in the heel area.
• Misalignments:
  • Foot misalignments such as flatfoot or supination increase the stress on the back of the heel.
• Inflammatory processes:
  • Chronic irritation and inflammation of the Achilles tendon or bursa can promote a Haglund's deformity.

The symptoms depend on the severity and progression of Haglund's deformity:

- Pain in the back of the heel:

- Especially when under stress or wearing shoes with a hard heel cap.

- Swelling and redness:

- Visible inflammation in the area of the bony protrusion.

- Tenderness:

- Pain when touching the affected area.

- Movement restrictions:

- Discomfort during activities such as walking, running, or climbing stairs.

- Thickening of the Achilles tendon:

- Chronic irritation can lead to a visible thickening of the tendon.

The diagnosis is based on a thorough medical history, clinical examination, and imaging techniques:

- **Medical History:**

- The doctor inquires about the duration and nature of the symptoms as well as possible triggering factors such as athletic activities or unsuitable footwear.

- **Physical Examination:**

- Palpation of the heel to assess swelling, tenderness, and mobility.

- **Imaging Techniques:**

- **X-ray:** Visualization of the bony protrusion and assessment of joint structures.

- **MRI:** Detailed visualization of tendons, bursae, and inflammatory processes.

- **Ultrasound:** Examination of soft tissue structures and fluid accumulations.

Conservative Therapy

Most cases can be treated without surgery:

• Pain Therapy:
  • Use of anti-inflammatory drugs (NSAIDs) like Ibuprofen to relieve pain and inflammation.
• Physiotherapy:
  • Exercises to stretch the Achilles tendon and strengthen the foot muscles.
  • Manual therapy to relieve tension and alleviate the heel.
• Shoe Adjustment:
  • Wearing soft, well-cushioned shoes without a hard heel cap.
  • Use of heel pads or insoles to relieve pressure.
• Cold Therapy:
  • Application of cold packs to reduce inflammation and swelling.
• Shock Wave Therapy:
  • Promotion of blood circulation and healing through mechanical stimuli.

Surgical Therapy

If conservative measures do not provide sufficient relief, surgical intervention may be necessary:

• Removal of the Bony Protrusion:
  • Surgical removal of the Haglund's deformity to relieve pressure.
• Bursa Removal:
  • Removal of inflamed bursae (retrocalcaneal bursitis).
• Tendon Correction:
  • Reconstruction of the Achilles tendon in advanced damage. 

To prevent Haglund's deformity, the following measures are recommended:

1. Shoe adjustment: Wear soft, well-fitting shoes without hard heel counters.
2. Regular stretching exercises: Stretching the Achilles tendon and calf muscles to improve flexibility.
3. Load management: Avoid excessive strain during sports activities.
4. Weight management: Reduce excess weight to minimize stress on the heel.
5. Early treatment: Immediate therapy at the first signs of discomfort to prevent chronic progression.