Haglund’s Deformity and Other Causes of Heel Pain in Runners

Runners, is your ‘Achilles heel’ your Achilles heel? Achilles-related pain is estimated to occur in nearly 10% of recreational runners every year (10) and over half of former elite male runners will experience it in their lifetime (23). Overuse injuries of the Achilles tendon are the most common reason for dropouts in athletic careers, especially in track and field (9). Loading of this tendon can reach up to 12.5 times a person’s body weight during running (6, 7) and the Achilles has a notoriously poor blood supply, so its ability to recover from injury is poor (1).

In this article, we discuss the most common types of heel pain, including Achilles tendonitis and plantar fasciopathy. However, we pay special attention to what has been termed a ‘mysterious’ yet ‘common’ heel-pain cause: Haglund’s deformity (20). Haglund’s deformity is where bone grows on the heel bone (calcaneus). This growth can cause pain and irritate the surrounding Achilles tendon and bursae (protective sacs). Together this collection of problems is called Haglund’s syndrome. We focus on Haglund’s deformity because:

  1. It seems to be diagnosed more and more often in the running community, but no studies have yet determined its prevalence;
  2. It closely mimics classic Achilles tendonitis but does not fully respond to/may get worse with the same treatments; and
  3. Why it develops and how to best treat it are still poorly understood.

As we await the study of Haglund’s deformity by the scientific community, we use this article to gather and organize runners’ anecdotal experiences to inform and perhaps benefit others with this injury.

An image showing Haglund’s syndrome in the right heel of Søren Rasmussen, a coach and 2:18 marathoner. Haglund’s syndrome is a bony growth that develops on the heel bone and creates bursitis and Achilles tendonitis. Image: Søren Rasmussen

The Basics of Heel Pain in Runners

The heel is fairly complex in its anatomy and determining the actual source of your pain can be quite challenging but necessary to start the right treatment.

Causes of Pain in the Back Portion of the Heel in Runners

  • Achilles tendonitis in the middle of the tendon or where the tendon attaches to the calcaneus – This is the chronic inflammation of the Achilles tendon where the load on the tendon exceeds the tendon’s ability to heal. Repeat micro-tears and swelling develop within the tendon and the more inflamed the tendon becomes, the worse the blood supply to it is and the harder it is to heal. It is ‘easier’ for the body to create new bone than new tendon, so often little areas of calcium develop in the tendon. This is called calcific tendonitis and usually occurs where the tendon attaches to the calcaneus.
  • Haglund’s deformity and/or syndrome – Haglund’s deformity is a bony growth/bone spur that develops on the calcaneus which can become painful when the bone rubs against a hard surface or when Haglund’s syndrome develops and there is associated inflammation of the bursae and Achilles tendon.
  • Stress fracture –A stress fracture occurs due to repetitive load on the calcaneus, which may cause pain in the back or bottom of the heel.
  • Achilles tendon tear/rupture – It is rare for a large Achilles tendon tear or rupture to develop in runners, but it can occur in a high-velocity injury. When a runner tells me they have an ‘Achilles tear,’ I usually figure it is a small tear that was identified and is a result of chronic Achilles tendonitis.

An illustration of heel anatomy showing the Achilles tendon, which is attached to the muscles of the calf above (gastrocnemius and soleus) and the calcaneus below. At the insertion of the Achilles on the calcaneus, there are two protective pads called bursae. Image: Webmd.com/fitness-exercise/picture-of-the-achilles-tendon#1

Causes of Pain in the Bottom Portion of the Heel in Runners

  • Plantar fasciitis/fasciopathy – Plantar fasciitis, now called plantar fasciopoathy, is the most common cause of pain in this portion of the heel and is due to the same type of problem that leads to Achilles tendonitis. The load on the fascia exceeds its ability to heal and chronic inflammation develops. In fact, the plantar fascia is actually connected to the Achilles and is very similar structurally. This is why the treatments for Achilles tendonitis and plantar fasciopathy are similar.
  • Fat pad atrophy – Fat pad atrophy is the second most common cause of heel pain on the bottom of the foot. It generally occurs in patients over the age of 40 and due to thinning of the fat pad on the bottom of the heel.
  • Stress fracture – Again, a calcaneus stress fracture occurs due to repetitive load, and pain from it can manifest in the bottom or back of the heel.

An illustration showing the plantar fascia (labeled ‘Plantar apon,’ short for plantar aponeurosis) which includes all of the visible white connective tissue. The left bottom line points to the heel’s fat pad. Image: Moore, 1999 (12)

There are other causes of heel pain not listed here, but these are the most common in runners. Let’s explore these specific conditions in more depth.

Achilles Tendonitis/Tendinosis in the Middle of the Tendon

Achilles tendonitis can occur in the middle of the Achilles tendon unrelated to any bony abnormality. This is called mid-substance Achilles tendonitis. Tendinosis is a term used to highlight the fact that it is a chronic condition. When the amount of load is too great and/or the blood supply insufficient for healing, micro-injuries accrue and lead to a chronic state of inflammation or tendonitis. The pain may be at its worst when getting out of bed in the morning, at the beginning or end of a run, or following a run. The pain does tend to ‘warm up’ in the middle of a run, unlike a stress fracture. Stretching also tends to relieve pain.

Strengthening the calf muscles, especially the soleus, increases the resilience and blood supply of the tendon and can be used to treat and prevent mid-substance Achilles tendonitis (2, 13). Heel lifts can also help in reducing pain due to tendonitis, but may put a runner at risk of shortening the tendon and potentially causing it to lose some of its elasticity. Chronic tendonitis may lead to bony enlargement/abnormalities on the calcaneus (5). Full-thickness tears can occur in the Achilles tendons of runners, but chronic tendonitis is much more common.

Insertional Achilles Tendonitis

This is tendonitis where the Achilles tendon attaches to the calcaneus and may include not only tendon swelling but also micro-tears and calcifications at the insertion site. Calcification can occur in a tendon as the body is attempting to heal it. Treatment may be the same as for mid-substance tendonitis, but if it is the calcification causing pain, then strength training will be less helpful and treatment should either focus on removing whatever is rubbing on the calcification (for example, the heel of running shoes) or removing the calcification through a needle or surgically.

Plantar Fasciopathy

Plantar fasciopathy, similarly to Achilles tendonitis, is due to damage of the plantar fascia at its origin on the calcaneus from the load on the fascia superseding its ability to heal. This typically causes pain in the sole of the heel and is at its worst in the morning when getting up from sleeping. The pain typically improves with running until it worsens at the end of and following a run. Ten percent of all people will have plantar fasciopathy in their lifetime (11) and running is a known risk factor (17).

Plantar fasciopathy can also be treated with high-load strength training of the soleus and gastrocnemius muscles in the calf (15, 13). There is also growing evidence for the use of platelet rich plasma (PRP) to treat Achilles tendonitis (3), plantar fasciopathy (8, 14), and tendonitis in general. The theory behind its efficacy is that it both improves the blood flow to areas that classically have poor blood flow for the amount of work that is required of them and that it may have a direct analgesic effect. However, it’s not expected that PRP could remove calcification.

Calcaneal Stress Fracture

A calcaneal stress fracture should also be considered with heel pain. A stress fracture typically does not hurt after sleeping and worsens with running or weight-bearing activities. The risk factors and treatment for stress fractures have been discussed previously in our bone-health article.

Fat Pad Atrophy

Fat pad atrophy can occur at the front or back of the foot’s sole. It is diagnosed by the visible thinning (to less than three millimeters in thickness) on ultrasound of the fat pad and there tends to be pain at the heel center or margin, worsening pain when barefoot or after a long period of standing, and/or tenderness on the heel center. Fat pad atrophy is the second most common cause of heel pain on the sole of the foot and it tends to occur after the age of 40 due to age-related thinning of the fat pad. The fat pad loses water, collagen, and elastic tissue which together reduce its shock absorbency and protection (22). It may also occur due to a complication of a steroid injection in athletes at any age (18).

Haglund’s Deformity

Now, what is the ‘mysterious’ condition called Haglund’s deformity? Haglund’s deformity is a condition where a bony enlargement on the back of the calcaneus develops. Why this happens is poorly understood but potentially due to chronic Achilles tendonitis, wearing high-heeled shoes, and repeated rubbing/friction in the area. Tight Achilles tendons, high arches, ‘heredity,’ and rigid shoes have also been suggested as causes, but to my knowledge no high-quality study has yet been done to determine this condition’s cause (20).

The arrow in this image points to a Haglund’s deformity. Image: Tu, 2018 (19)

Haglund’s deformity often becomes Haglund’s syndrome, which involves the bony growth plus bursitis plus Achilles tendonitis. Friction on the bony growth causes the other two problems to occur and all of this together can be really painful.

Diagnosis can be made with history, physical examination, possibly x-ray, and ultrasound. High-quality ultrasound may be more useful than x-ray as it can find very small bony growths.

Haglund’s Deformity Deep Dive

We’ll spend the rest of this article deep diving into Haglund’s deformity. I have had a Haglund’s deformity for years, and both ultrasound and x-ray imaging from mine over this time can help us understand the injury a little better.

My ultrasound image shows classic Haglund’s syndrome. My swollen retrocalcaneal bursa is outlined in red, the bone spur is in blue, and the somewhat swollen Achilles tendon is in green. You can clearly see how the bone spur could rub the bursa, causing the bursa to leak into and push on the tendon. I was having pain at the time of this ultrasound. Image: Tracy Hoeg

X-ray images of my two heels while I had Haglund’s syndrome symptoms. The left image is my affected heel and the right my uninjured heel. As you can see, the Haglund’s deformity cannot be seen on x-ray, though it was clearly visible on ultrasound. Image: Tracy Høeg

The increased use of ultrasound and awareness of the condition may be two of the reasons more and more people seem to be diagnosed with Haglund’s deformity. As for me, my condition became a lot less painful once I received PRP in early 2019. (I wrote about this in our regenerative-medicine article.) This treated the tendonitis, but the irritation/mild pain and swelling from the bursa persisted… until quite recently.

Shoe Modification for Runners with Haglund’s Deformity

To be clear, the scientific literature does not yet describe if the bony protrusion/heel bump will resolve or regress if the irritating source (such as a hard-heeled shoe, high-heeled shoe, possibly longstanding insertional Achilles tendonitis, and more) is removed. However, it is anecdotally estimated that 50% of cases of Haglund’s deformity can be treated by removing the aspect of the shoe which is rubbing on the bony protrusion (4). Let’s look at three runners and one soccer player who altered their shoes for Haglund’s deformities (or suspected Haglund’s deformities).

Runner Søren Rasmussen’s shoe modification where he removed the hard, inner plastic of the shoe’s heel, but retained the shoe’s integrity. Image: Søren Rasmussen

Runner Chris Cochrane’s modified shoe. Image: Traileffect.com/2017/05/the-curse-of-pointy-heels-modifying.com

The modified shoe of professional soccer player Philippe Coutinho photographed in 2017. Though Coutinho has never confirmed this, this shoe modification could be to relieve Haglund’s deformity. The next year, in 2018, Coutinho had updated shoes, custom Nike Mercurial Vapor 11’s where the outer liner of the shoe appeared to cover a hole in the harder shoe lining. Image: Anfieldhq.com

My modified shoe. Image: Tracy Høeg

Haglund’s deformity and shoe altering for it was also recently discussed on the LetsRun forum. While I’m not sure where one of the commenters ‘Marketing guy’ got that 25% of the population has a Haglund’s deformity, it’s certainly a common problem in runners. I am also surprised there seems to be a total lack of shoes available to accommodate this.

Now, let’s examine before-and-after pictures of the heels of two runners prior to and after removing the hard, plastic heel of their running shoes.

Søren Rasmussen’s heels before (left) and after (right) removing the hard plastic from the back of his right shoe. Following a period of shoe modifications and identification of shoes which did not rub on his bony heel growth, Søren has a less swollen and less painful heel. While his heels don’t appear completely symmetric, he can now run and walk mostly without pain. Søren seems overall happy he did not have surgery done, but denies that his heel feels ‘perfect.’ He is currently able to race at a highly competitive level, but does intermittently get heel pain. Images: Søren Rasmussen

My heel before (left) and then two weeks after (right) modifying my left shoe. I also had a noticeable decrease in the size of my heel and the discomfort I felt in it. Once again, there still appears to be some swelling, but the pain is gone. I ran more than 100 miles the week before I took the ‘after’ image, and I am hopeful that the remaining bursitis/swelling will disappear over time. Certainly my tiny bone spur itself is not the cause of the remaining bump, but the residual thick fluid in the bursa is. Images: Tracy Høeg

Yes, you saw it here first, before in the scientific literature! Shoe alteration helps some runners.

Surgery for Runners with Haglund’s Deformity

Though surgical excision of the bony growth of the calcaneus is only required in resistant cases (20), it seems many athletes are being convinced that surgery is the only valid option. And perhaps it is for some people.

Case Studies of Haglund’s Deformity in Runners

Here are four case studies of runners with Haglund’s deformity and the methods they used to treat it.

Case #1: Gwen Jorgensen

Gwen Jorgensen is a professional distance runner and former triathlete who won the gold medal in triathlon at the 2016 Olympics. Gwen developed heel pain in 2017 that was eventually found to be due to a Haglund’s deformity causing retrocalcaneal bursitis and Achilles tendonitis–also known as Haglund’s syndrome. She was treated successfully for Achilles tendonitis with PRP but as soon as she started training and racing again, the pain came back, this time mostly due to the Haglund’s and bursitis.

In an interview with Rich Roll, she described how Nike made a custom shoe for her with spikes and a larger heel drop. She also stated on her YouTube channel that she liked the shoe because “it doesn’t put as much pressure on my heel.” Unfortunately, the injury didn’t improve and she had surgery–once she found a surgeon who would not cut into her Achilles tendon, but operated on the calcaneus and bursae only (16). This is the Achilles-sparing type of surgery for Haglund’s deformity. To be clear, the previous standard procedure usually involved lifting up part of the Achilles tendon from the bone, debriding (cleaning up) the tendon, and then reattaching it (21). In another YouTube video on her channel, Gwen describes her decision to pursue surgery.

Gwen Jorgensen’s modified Nike Vaporfly 4%. Image: Youtube.com/watch?v=F6cFK2szjdg

At the time of this article’s writing, Gwen is about five months post-surgery. I reached out to her and she was kind enough to respond in a written message that she was happy she had the surgery, had failed with trying shoe modifications, and was running again.

Case #2: Jenny Hitchings

Jenny Hitchings is a 56-year-old runner on the Sacramento Running Association Elite Team in California. In an interview, she described her experience, “I battled Haglund’s and sore Achilles tendons for a few years. My left was worse in the beginning but I ended up having surgery on my right! I tried everything before resorting to surgery, including physical therapy, massage, bone stimulators, extracorporeal shockwave therapy, electronic muscle stimulation, ultrasound, cutting holes in my shoes, and time off. Nothing gave me relief. The surgery included taking one inch off the heel bone, cleaning up the Achilles and bursae, and PRP. I did no running for 12 weeks. But I may have started too soon and ran an easy 10-mile race and that set me back three more months! I was really out for six months or so. But when I started racing again, I have never had heel or Achilles issues again.”

Jenny Hitchings running after recovering from Haglund’s surgery. Image: Molly Hitchings

Case #3: Rob Krar

Ultrarunner Rob Krar was also diagnosed with Haglund’s deformity on both heels after an intense period of training and racing in 2009. He underwent the recommended surgery on both heels in April of 2010 and took about two years away from running before he fully recovered. He went on to win the Western States 100 twice in 2014 and 2015 and much more. I was thrilled to speak with Rob for this article.

Rob Krar on his way to winning the 2015 Western States 100 after recovering from surgery for Haglund’s deformity on both of his heels. Photo: iRunFar/Meghan Hicks

iRunFar: How long did you have Haglund’s symptoms before your diagnosis?

Rob Krar: It’s hard to remember exactly when the symptoms began. My feet in general had been troublesome since 2007, and working 10-hour graveyard shifts while standing on my feet [in my previous career] didn’t help. My symptoms were quite severe from January to August of 2009 when I was training for the TransRockies Run (TRR). I trained and raced TRR with a compensated stride and pinched my sciatic nerve just a half mile from the finish after six days and 120 miles of running. I couldn’t run again until January of 2010, and even after four months away from running, the pain was worse. The bumps on my heels were just as big, if not bigger, and it hurt to even walk or hike. Ultimately both my heels were just as bad and I had surgery on both at the same time.

iRunFar: Did you find out what caused your Haglund’s?

Krar: No. The Haglund’s seems to remain a bit of a mystery, at least in my experience.

iRunFar: Did you try modifying your shoes to accommodate the deformities before surgery?

Krar: Not to try and resolve the issue. Once they were there, they weren’t going away. I tried cutting holes in the back of a few shoes to relieve the pressure with mixed results.

iRunFar: Do you know what type of surgery you had? Was it Achilles-sparing?

Krar: My surgery was Achilles-sparing, although my surgeon had my permission to detach my Achilles if he felt it was the best option once he was in there and had a better look. Interestingly, I’d never heard of Haglund’s until I had it, but since then it seems to be more and more common. I’ve had countless inquiries from others asking for my thoughts.

iRunFar: What happened after the surgery, in your recovery?

Krar: My surgeon told me to expect a year of recovery before running comfortably again. Like many impatient runners, I rushed that timeline and tried running about three months after surgery. It was a terrible idea. I set my recovery back and ultimately gave up the idea of ever running, let alone racing, again. I was not a model of perseverance and determination at the time and at times the frustration was overwhelming.

It wasn’t until May of 2011 (13 months post-surgery) that I started running some short and slow runs with my wife and that I realized the pain had subsided and I could get back out on the trails. It was a balancing act though, too much speed or distance and I’d be out a couple days letting my heels settle down. The rest of 2011 was more of the same and I’d still not entertained any idea of returning to training and racing.

The winter of 2011/2012 was the turnaround for me. I didn’t run a step, but logged huge vertical while ski mountaineering, unknowingly getting myself into ridiculously good shape. I jumped into the Moab Red Hot 33k in February (22 months post-surgery) with no running under my legs. I won the race and felt great. From that point on, my heels were mostly good to go and I dove head first back into significant training and racing with only a few mild and short flare-ups.

I think the point is that although each individual is different, from the Haglund’s surgery folks I’ve spoken to, nearly everyone has the same story, including myself: have surgery, come back too soon, and set yourself back. The difference is those who completely walk away for some time seem to succeed the most in returning to full competitiveness and those who continue to play the cat-and-mouse game end up walking away for good.

These days when I’m in my heaviest training phases, my heels still ache and I have to nurse them along, but they don’t get in the way of racing to my potential. I have little doubt now, nine years post-surgery, that it was the best decision for me at that time.

Case #4: Tracy Høeg (the Author)

Wrapping up with my own experience, I have had a very similar course to Gwen Jorgensen, prior to her surgery. I’ve had swelling and pain in my posterior heel since 2013, which would initially come and go and then just would not go away starting a little over a year ago. It seemed to only partially respond to eccentric calf loading (heel lowerings).

After the New Year’s Resolution Race in Auburn in January of 2019, I had a worsening of my heel pain and did a high-resolution ultrasound on my Achilles tendon. I could clearly see a bone spur, diffuse Achilles tendonitis around a tear, and increased fluid volume in my retrocalcaneal bursa. I had the previously mentioned PRP treatment to my Achilles. Three months later, the pain was better, but the swelling was still there, albeit less, and my tendon mechanics were still off. I rescanned my tendon and indeed saw resolution of the tendonitis and tear, but the bone spur and retrocalcaneal bursitis remained.

My coworker attempted to aspirate the fluid out of my bursa, but it was actually a gel-like substance which was too thick to suck out even with a large-bore needle. Ouch! My interpretation of this is that it was previously very swollen and filled with fluid. As the fluid leaked out and the inflammation resolved, inflammatory cells remained in the bursa and created this gel. This is likely why people retain a sizable bump on their heel long after the active inflammation is gone. Whether this bump affects Achilles function, I do not know.

Then something really lucky happened: I got a blister on my heel from new running shoes. This led me to cut a hole in the heel of my normal running shoes which allowed me to run without heel pain. After now seeming to be able to run endless miles, I find myself wondering how many other runners with Haglund’s deformity/a calcaneal bone spur could also benefit from a running-shoe plastitectomy rather than an invasive surgery. I also find myself wondering where I can buy a pair or two of heel-less running shoes. I suspect that whether or not shoe modifications will be successful depends on the location and size of the heel deformity, the shoe type, and the type of modification done to the shoe.

Final Thoughts on Haglund’s Deformity

When is surgery indicated for Haglund’s? When can a much simpler shoe modification be done instead? How can this condition be prevented? I am ending with perhaps more questions than answers, but I hope this article will bring attention to and conversation about a common, often devastating, and poorly understood condition.

Call for Comments

Have you suffered from or do you suffer from Haglund’s deformity or syndrome? Have you had success with any treatment? We would love to hear your story.


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Tracy Beth Høeg MD, PhD

is currently a Sports and Spine Medicine physician at Mountain View Rehabilitation in Grass Valley, California, and an assistant professor at UC Davis. She completed residency in Physical Medicine and Rehabilitation at UC Davis and a PhD in Ophthalmology at The University of Copenhagen. She is a Danish-American double citizen who ran for the United States at the 2013 IAU Trail World Championships and for Denmark at the 2018 WMRA Long Distance Mountain Running Championships. She is married to Dr. Rasmus Høeg and they have two sons.

There are 53 comments

  1. Wendy L. Wheeler-jacobs

    Thank you for covering Haglund’s. I have been cutting holes in my heels for years after noticing I was wearing the holes in the back of the shoe anyhow. I was finally able to settle it down and find the right shoe/orthotic combination to alleviate the pressure, but it took several months before I could run without the pain. I recently won a different pair of shoes, and unfortunately irritated the heel again after wearing them out for only 2 runs/25 miles. So you need to be constantly aware of it.

  2. Nick

    I was recently diagnosed with Haglund’s after it was misdiagnosed as insertional Achilles tendinosis for almost five years by several different physical therapists. I should have been referred to an orthopedist long ago, because they seemed to know it was Haglund’s the instant they examined me, but I kept on doing the eccentric heel drop/stabilizing exercise game thinking it would eventually stick.

    I even invented new exercises with kettle bells that seemed to help. I’ve done shoe modification, removing the heel cup but maintaining the soft heel material, and it does help alleviate symptoms. I carried a heel lift during races for when things got bad. I also used a graston tool to calm the area, which works for about half an hour.

    But I got to the point recently where I decided surgery was the only option – I enjoy long races, and it has started to get exceptionally painful at 50 miles, to the point that by 100 miles I’m hobbling and can no longer flex my ankle. And I also looked at all the ridiculous modalities I was applying and I realized this was something I could not fix.

    It seems like there are two recovery stories for Haglund’s surgery – folks running within a few months and doing fine, and other folks like Rob needing to take at least a year to get back to normal. There doesn’t seem to be a rhyme or reason to who gets which experience. But at this point, even though I’ve been racing/running for four years with Hadlund’s…I haven’t really been racing or running like I used to. So I suppose my perspective is that I shouldn’t be hurried to get back to running – because I haven’t been doing it for “real” for a while, anyway!

    If I could give folks some advice – if you get an Achilles injury that seems to be right on the bone and is accompanied by even minor swelling, and it doesn’t respond to treatment and relative rest after 6 months or so, or it flares up during runs and goes away within a day – go see an orthopedist and get some imaging. At worst, you will be out an office visit and copay, and at best, you will save yourself time, which is something you can never get back. I will never get five years of poor running and racing back. But I’m hopeful that with surgery, I will get back the future running I would otherwise never have.

  3. Jim Skaggs

    Very interesting article. I had surgery for Haglund’s in Oct. 2017. The doc did detach my achilles. He did tell me to expect a year long recovery, three months no weight bearing, a boot for 8 weeks, and no running for five months. Although I was a bit impatient at times, I did listen to my doc and didn’t even try running until about 4.5 months, and then for only very short stretches. I also found a very good PT post surgery. I mentioned that my goal was to run Wasatch 100 in 2018. He thought I was crazy, but to his credit said let’s do it. I did run and complete Wasatch 11 months after surgery. It wasn’t fast (but neither am I), but I got it done. Two years post surgery and that achilles is doing just fine. The key for me was being patient and listening to my doc and PT. I had no setbacks at all, it was just a long grind to get back in shape. I don’t quite have the flexibility in that leg that I used to, but it doesn’t stop or slow me down (age is doing a very adequate job of that). BTW, I have pics from my surgery if anyone wants to see them :-)

  4. Jessi G

    I had surgery for Haglund’s in Aug 2017 (I had also initially been diagnosed with insertional Achilles tendinosis two years prior). I went to the Alfredson Tendon clinic in Sweden as I knew he would not detach the tendon (and even out of pocket with travel costs was cheaper than getting it done in the US!). I had my achilles bursa and the bone spur removed – I was running again in about 10 weeks. It took a little while before I could ramp up the mileage but I’m back to running ultras now with no issues – at least not related to the Haglunds. :-) For me having the surgery was completely worth it!

    1. Nick

      Jessi (and Jim),

      Any advice on what to watch for when returning from surgery?

      In the article Rob mentions needing to let his heels settle down…have you experienced inflammation, deep achy bone pains, tendon issues, etc., that guided you on when you could return to running and increase mileage? Did it take longer to feel comfortable running hills/technical trails?

      1. Jessi

        Hi Nick – I was given a conservative plan to ease back into running very slowly around 8-10 weeks after my surgery (I think my first run was less than mile with walk breaks) and not more than 3 days a week initially and only flat/on track. Since that went well, being a typical runner I of course then jumped right into a 10k trail race before I should have and set myself back a little. I was back on trails before the end of 2017 but was just really cautious and backed off on mileage if I felt any soreness that lasted more for than a day. (Interestingly it was typically speedwork and not technical trails that would cause me discomfort the next day.) The area where I had the bone spur and bursa removed filled in with soft tissue that would get really tight after a run – I found that if I just stretched it and did the PT exercises I was given I was fine within a day. I did try to reduce inflammation overall (supplements, topicals, diet, etc) and I was also working with a PT that was helping to guide me after I had overdone it initially. I did a 100k the following May (9 months post-surgery) with no issues during my training or during the race and a 100 miler later that year. I have zero regrets with my decision to have the surgery – I should have just been a little more cautious initially about not pushing too soon to get back to it. But everything ended up all good in the end. :-) I hope this helps!

      2. Jim Skaggs

        I had a bunch of takeaways. First, I found an ortho that specializes in ankle/achilles and sports injuries. It did help that his wife is a fellow ultrarunner that I occasionally run with. Second, I knew of a couple of people that had the surgery and tried to get back running too soon. Set them back a couple of years, so like Jessi said, be conservative and listen to your doc. Third, like I mentioned in my comment above, find a good PT that understands runners. Mine was pure gold. When I finished Wasatch, I stopped by his office to show him the plaque and buckle. He was so excited to see it.
        Understand that total recovery will take about a year. Once I was back running I found that my gait was off, my leg had atrophied big time, I was scared to fall, scared to jump off anything higher than a few inches. I had some residual nerve pain that made me think that I was undoing the surgery. I had times during recovery when I wondered if it was worth it, if I would ever get back to running “normally”. It took awhile to get back to running hills and technical stuff. I really listened to what my body was telling me as I got back running. I did push my training because of a short training window, but backed off when I thought I needed to. Cross train. My doc let me get into a pool and swim laps while I was still in the boot. The day I was out of the boot, he gave me permission to get back into the gym, so I did.
        Hope that helps a bit.

      3. Andrew

        Hi Nick,
        I also had surgery for Haglund’s (remove Achilles, shave down bone spur, debride Achilles, reattach Achilles), in 2013. My experience was a bit different from Jessi and Jim. It took me about 2 years to return to regular running, and I didn’t run an ultra until 2016. During that time I had intermittent pain and swelling that guided how much I could run. I was a bit conservative and stopped running when there was any noticeable pain after the first few minutes running. I found that road running hurt more than trail running, and I didn’t regularly run on roads until 2018. The same goes for running uphill, which I didn’t do on grades more than about 8% until 2018. Technical trails didn’t pose that much of an issue as I greatly increased my ankle mobility during the recovery process.
        During the 2 years where I was running minimally, I really thought I would never be able to return to the sport. It took longer than I anticipated, but I eventually did return to ultrarunning.

    2. Mike

      Hey Jessi, I got Haglund’s deformity on both feet, probably early stage comparing to photos I can find online. What was the cost of surgery performed by Mr. Alfredson in Sweden? Did you have to do both feet or just one? I’m depressed because of this problem, was a pro climber and very worried now. Looking for solutions and endoscopic surgery, wouldn’t like to get tendons detached.

  5. Oscar

    Great article! Galen Rupp recently just came back to racing after being away for a year from surgery for his Haglund deformity. I believe he did have his achilles detached. There are some videos out there showing what his recovery process entailed.

      1. Oscar

        Yes Tracy, he ended up dropping out towards the end of the race, had a calf issue. Hopefully not related to the surgery, but I haven’t found any other updates yet.

  6. Mike Jones

    I am going to have the surgery performed on my foot this upcoming winter. After a number of years dealing with the inflammation on my own I finally went to an orthopedic specialist. I went through a few months of PT and while that did get rid of the inflammation, the problem persisted after returning to running. The inflammation seemed to get worse and worse over time and for the last races I did I was limping in the last few weeks before the race. I’ve tried shoe modifications and while they do allow me to run with much less pain, any running done over an hour or with more intensity will cause irritation and inflammation on the insertional part of my Achilles. I know a good number of runners who have gotten the surgery done within the last year and they all are glad to have had it done. My surgery will just remove the bone spur portion and not detach the Achilles as I have no signs of fraying or damage to the Achilles at this point. It looks like the key to a good recovery is being patient and easing the return back to running.

    P.S. Another person who had the surgery is the top american at the Chicago Marathon this last weekend Jacob Riley.
    He had an article on podium runner about his recovery and return to racing

  7. GMack

    Thank you for a wonderful article.

    My Haglund’s was caused by running inclines. I’m also a forefoot runner which doesn’t seem to help.

    About 8 years ago when the condition flared up, I’d do a shoe modification which helped tremendously.

    I’d use a heat gun to soften up the plastic heal cup, alternating outside to inside and being careful not to melt the shoe’s inner liner. Then use the back end of a screwdriver which is the same size as my heel bump and push out a divot from the inside of the shoe creating heel space.

    It’s reliable and doesn’t drastically alter the back of the shoe.

    I’ve talked to a doctor and decided against surgery. I’m in my 50’s and the time on my butt recovering and future ultrarunning years didn’t seem to warrant it.

  8. George Ruiz

    I had battled Achilles’ tendon pain for about 10 years before it really started to be so painful I started to get physical therapy that included everything from PRP, dry needling and tooling to break up scar tissue. Basically it was all miss diagnosed as simple Achilles tendinitis. After 20-100 milers and countless other ultra distance races I could hardly walk or hike with out extreme pain.

    I was finally referred to a foot and ankle specialist. He too one look at my heal and wrote on his card, Haglund’s Deformity. WTF is this? After the MRI he told me it was in really bad shape and a complete tear from the insertion was imminent. There was no possibility to have a non invasive surgery with the Achilles.

    Once the surgeon was in there, there was evidence of many years of tearing and calcination. After taking down the calcaneal spur and another heal spur, the debriding of the tendon fiber as extensive, so much so he needed to harvest FHL tendon from my big toe. It was harvested through my heal and used to reattach Achilles’ tendon with bio-ten odes is screws.

    It was a really major repair and rebuild of my Achilles. I’m happy to say after 35 weeks I’m done with PT and hiking walking without pain and have recently introduced running a couple of miles a few days a week. I still have a long ways to go and reach the “one year” bench mark to be fully recovered. It scares to read Rod Karr was out for two years before running. I’m trying to keep the rains pulled back and not over do it.

    I’m I glad I had the surgery, yes but I didn’t really have a choice, I could do much of anything any way. Will I be an ultra runner again, I don’t know and it doesn’t really matter, I can walk and hike and run a few miles with out pain.

    As Ultra Runner’s, that is all we do is run though pain. I can say from experience, if your reading this have acute Achilles’ tendon pain, get it handled now and don’t run through it. It will only progress into something like Haglund’s, it’s not a fun fix. I never heard of this before that office visit, but now I’m hearing more ultra runners that I thought have had this so listen to your body, or better your heal pain!

    1. Jim Skaggs

      That’s exactly what the surgeon did to mine. Grabbed a chunk of tendon from teh bottom of my big toe (I can’t bend it very well now). I think you’re around the same age as I am (61). I’m back doing ultras pretty much whenever I want, so there is hope if that’s what you want to do. Good luck with your continued recovery.

      1. George Ruiz

        Thanks Jim. Good to know a few that have been through it! I read your comments about nerve and bone pain that scares you that everything is being undone. I get that And it scares me, but that’s a good thing to keep a healthy respect!

        I’ll be 63 in a few months so I’m not sure how many ultras I have left in me or want to train for. Getting ready for ski season is my main focus now!

  9. Joe Uhan

    First off: another outstanding article by Dr. Høeg! So thorough and information-rich! And the runner case studies are also insightful.

    I’d like to add some clinical perspective as well:

    * Haglund’s Deformity is a bony hypertrophy in response to [over-]stress. This is a pervaisive physiological adaptation of bone to any over-stress. In kids, we see these syndromes as “Severe’s Disease” (heel) and “Osgood-Schaltter” (knee). And while some pediatricians/orthopedics simply write these off to “growing pains”, these are indeed issues of bony over-stress due to **inefficient overloading** at the heel and knee, respective

    Haglund’s has the same origins: over-loading of the heel. The question is why:

    * Haglund’s is driven by **footstrike landing inefficiency**. Over-striding — the most common running gait inefficiency — and “over-pronation” are the top two stressors that add chronic overload to the heel, via the gastroc-soleus-Achilles mechanism. This chronic overload pulls-pulls-pulls on this complex, causing bony hypertrophy.

    The tipping point for Haglund’s is when that bony over-growth gets so big that it begins to interfere with normal tissue function (bursa, tendon, etc).

    * Haglund’s Deformity is very similar to other bony over-growth issues: calcaneal bone spurs (often found in folks with plantar foot pain) and subacromial (shoulder) bone spurs. And here’s what we know about them:

    1. They are hypertrophic responses to [excess/inefficient] load
    2. They **do not necessarily CREATE pain**!

    This is an improtant distinction. Many studies, for example, have found no association between heel spurs and pain (in other words: some folks have them, with zero heel pain; some people have nasty heel pain with no bone spurs).

    Can the same thing be true with Haglund’s? Can you have a sizeable deformity with no pain? / No deformity and tons of pain?

    My thought is Yes.

    This brings up function: if a runner continues to over-stride or (possibly worse) narrow stride^, the pain will not go away, whether you have the surgery or not.

    (^ https://www.irunfar.com/2013/03/going-wide-the-role-of-stride-width-in-running-injury-and-economy.html)

    A landing inefficiency will continue to produce excessive ankle/heel stress.

    As such, a couple final points:

    * First, it seems that if cutting the back of your heel off the shoe alleivates/abolishes the pain, that’s a strong indication you have the retrocalcaneal bursa pain associated with Haglund’s — thus, that deformity IS relevant

    * Second, fixing stride efficiency is a must-do: whether you have surgery or not. And if faced with a year+ rehab (and/or you cannot afford that time/$$$), investing in stride optimization is an absolute must.

    – It starts with posture: https://www.irunfar.com/2018/11/posture-first-how-alignment-affects-our-running.html
    – which leads to sufficient hip hinge: https://www.irunfar.com/2014/08/the-best-running-exercise-that-no-one-is-doing.html
    – being mindful of landing underneath your center of mass: https://www.irunfar.com/2014/07/the-pawback-drill-for-trail-runners.html
    – and landing whole-foot: https://www.irunfar.com/2015/05/elite-feet-strong-strides-start-at-the-foot.html
    – and underneath (but not too narrow): https://www.irunfar.com/2013/03/going-wide-the-role-of-stride-width-in-running-injury-and-economy.html

    (Of note, both Rob Krar and Gwen Jorgenson (especially!) have had (or still have) postural deficits of excessive lumbar extension and deficient hip hinge that results in over-stride landing stress)

    1. GMack

      I hadn’t seen the post on “going wide” but had figured on my own this was the was the way to alleviate Haglund’s and occasional Achilles pain.

      Watching my footstrike pattern in a mirror while on a treadmill, I could tell I was running heal-to-toe. This was a running habit I apparently picked up running on narrow trails.

      This didn’t seem natural so I tried widening my stride (when not on narrow trails). The problem wasn’t completely solved but it did help.

      I’m naturally a forefoot runner and supinator, so I also tried moving my footstrike back to midfoot and keeping my foot level on impact. This greatly helped and was only possible by running wide.

      I don’t think my Haglund’s is as bad as some of the other commenters and won’t go under the knife. The key is awareness and prompt running form corrections if you get symptoms.

      1. Mike Jones


        My haglunds was caused by limited ROM on my affected foot dorsiflexion, effectively tightening up my calf on that side. While I’ve known about my condition for a few years, it was only in the last year that it has gotten to the point that I would need surgery to run without inflaming my Achilles again. Had I made changes earlier a few years ago I might not have needed surgery.

  10. Chris

    I know this article is concentrating on Haglund’s, which I know will be helpful to those dealing with that, but what about help for those suffering the indignity of fat pad atrophy? Treatments? Injections from another area? Super cushioned shoes?

  11. Michael Schneider

    I developed posterior heel pain I thought was Achilles Tendonitis but then was diagnosed as Haglund’s deformity. (The pain went away quickly, wearing a pair of backless Birkenstocks, which should have been the tip off….) The one pair of trainers that worked marvels for me was the Salomon Predict RA. Instead of a rigid plastic heel cup, like all of my formerly preferred shoes from Asics and Mizuno, the upper is like a tight but soft latex wrap all around. Amazing and durable relief – got back to short, 4K runs easily, and am looking forward to more!

  12. Kate Mack

    I am a 55 year old female runner who suffered from Haglund’s deformity first in my right foot and then five years later in my left. I was a Division I collegiate swimmer who took up running once I retired from swimming. By my mid-30’s I was a regular 40-45 mile per week runner: 5K, 10K, half marathoner, marathoner with a marathon PB of 3:11. I had a two week stint at about age 38 where I had plantar fasciitis in my right foot. An orthopedic surgeon gave me orthotics for both feet and I never had the plantars again. I also wore Brooks shoes religiously for probably 10-12 years. I rarely wore high heels and mostly wore mules and flip flops during the day. I started feeling a pull and stabbing pain in the back of my right heel/ankle around age 43. I also noticed that I’d been wearing out a spot in all my running shoes on the inside of the back of the shoe and my foot hurt to walk when I first got out of bed. I tried a lot of things – stretching my Achilles more, writing the A,B, C’s with my toes before I got out of bed, wearing a night guard that kept my foot dorsey flexed all night, I iced it post runs and before bed. This helped some. I kept running but I didn’t do any races and I had to wait to get my foot warmed up for an hour or two in the morning before I could run my 8-10 miles. Plus then later in the day it would hurt to walk. From age 42-45 years this phenomenon progressed to the point that I stopped running altogether the summer I was 45 and I got scared because I realized that even with quitting running, I couldn’t walk at a normal pace because even that hurt. I only wore backless shoes and still the pain didn’t go away. So in November of my 45th year I had surgery for Haglunds – detaching the achilles, smoothing out the calcaneus, debriding the scar tissue and the agitated achilles tendon. I had a fabulous surgeon and it was an easy operation. I would tell anyone who gets to this point of pain when running/walking to get the surgery (do your homework and have a true orthopedic surgeon who does a lot of Haglund’s surgeries do it…don’t go with just anyone) The down side the surgeon tells you up front is that it takes a lot of post surgery time to make sure the re-attached achilles heals properly. This is the truth. Listen to this advice and don’t try to start running too early. Get on a spin bike once you’ve been told you can but let the running go for awhile if you want the surgery to work. Don’t plan on running for 4 – 5 months. Listen to your surgeon, be conservative…you want this pain gone. Don’t plan on racing for probably 18 months to 2 years. I know it sucks. In the scheme of things this is not a big deal amount of time when you are talking about being able to walk and run without pain. Give your running muscles a break. There are other types of cardio you can do while the achilles heals. I started a “walk to run” plan with my doctor at 4-5 months post surgery and by 12 months post surgery I was running 2 miles normal again. By 2 years post surgery I was running 8-10 miles a day daily.

    That said 5 years after my right foot was operated on my left foot was operated on for Haglund’s. The funny thing is that when I had the right one done there was zero indication that the left one was going to go bad on me. Surgery on the left went great and like the right foot 5 years prior I was back to running 2 – 4 miles at 12 months post surgery.

    Why did I get Haglund’s? A variety of reasons – some of them related to my foot anatomy and some of it was probably preventable had I known how to exercise and help my feet get stronger. Anatomically: I have naturally high arches and my second toe is a tiny bit longer than my big toe…hence I strike harder with the 2nd metatarsal than with the first which causes me to stress my foot at the point where the achilles attaches to the calcaneous. I would guess that after years and years of running this force on the attachment adds up to scar tissue and the Haglunds bump. I also was prone to tight hamstrings and calves and my forward dorsey ankle flexion was poor. I wish I had been someone who did pilates starting as a teenager and had learned the importance of having strong feet and keeping my ankles stretched. Ballet dancers develop strong feet but unfortunately I didn’t dance so mine are swimmer flippers. Had I done pilates I would have learned how to exercise the many foot, toe, ankle and calf muscles. I highly recommend pilates to all runners to learn how to take care of your feet. I also think that wearing orthotics along with wearing the same shoe style for a decade contributed to my Haglunds. When I ran my foot was always in the same position no change in ankle position etc and on hard surfaces mostly. These days I try to wear several different types of shoes and purposely do not wear an orthotic. I never thought one could change how they run but you can — I work on how my feet strike the ground and try to strike with my first and second metatarsal as I am prone to let my feet strike more with my my 2nd and third. Changing up how I use my feet when I run and running on soft trails (never hard roads) has keep me running healthy now for the past 3 years. The Haglund’s pain has never come back. Right now I have a couple pairs of each of the following shoes that I change up through the course of a week of running: Hoka Clifton(4 pairs), Brooks Glycerins (2 pairs) and I used to love a shoe called Mizuno Elixir but they took it off the market – it had the softest back, heel count, no rubbing and was so comfortable. I always check for new styles that are soft and don’t constrict or dig around the back of the heel. And I go for neutral shoes because I want to correct any incorrect tendencies I have by strengthening my feet on my own, not by being bound in a control shoe. I go to pilates at least once a week and work my feet, toes, ankles and calves. I also always take my shoes off right after I have finished a run. I don’t walk around in sweaty socks and running shoes, I want my foot to breath and get dry and I continue to wear backless shoes – mules, flip flops a lot of the time. I never wear any shoe that rubs the back of my feet, if I find a pair is doing that I get rid of them immediately.

    Thank you for this forum on Haglund’s. When I was suffering with Haglund’s at age 42-45 I spent a lot of time searching online for anyone out there who could talk about Haglund’s. It was hard to find information. I searched for ways to not have to quit racing. Hate to say it but that is what ended up happening…but at least I can still run 6-8 miles 7 mornings a week and get that fabulous running high. There was a time when I thought I never would. And if I really wanted to race I could, I have no pain doing it. I’m just old enough now that it’s not the thing that I’ve driving after, maybe that bug will bite again in the future? I am glad for blogs like this that let Haglund’s sufferers air their experiences and hopefully avoid what happened to me or if you do have bad pain you can learn that getting the surgery is not a big deal as long as you use a foot orthopedic surgeon that a fellow runner has successfully used, one who has great surgical outcomes. And they’re are definitely foot orthopedic surgeons out there trained to do this. It’s the recovery that takes serious will power.

  13. Joe G

    The article was great, but the comments have been so helpful. George and Jim, reading your stories and your ages has given me strength. I’m lined up to have the surgery to remove Haglund’s bump and repair tendon in three weeks. My treatment story started December 2018 when I woke up the day after a comfortable 17 miles run and unable to flex my foot. Made no sense as nothing happened on the run. A few weeks prior, I finished my 20th 100-mile race and yes, I felt soreness at insertion during the race, I dont recall feeling anything so debilitating that I should have stopped. Anyway, an MRI showed a partial tear of the posterior achilles at insertion. Dr. felt thickness of tear didnt warrant surgery as first option and wanted me to try physical therapy. I will add that he was well aware of my ultrarunning and the possibility I would race a rugged trail 100 in July 2019 and wanted to see that happen.
    7 months of physical therapy and gradual return to running. Didnt run in the 100, but did a couple trail marathons and a 50k. After every run, whether 4 miles or 30 miles, there was inflammation that I attended to with ice and a couple of days off. I didnt think anything was wrong, I was running again and this was just my body adapting.
    I did a trail marathon in January on a very muddy course. A week later and the inflammation had not gone away.
    I had an MRI and learned that I have another tear in the same area. I was upset thinking that I blew a everything I did in the past year in one day but that wasnt the case at all. Seems all along the tendon was rubbing and getting a little bit worn.
    When Dr saw new MRI, he spoke to me on phone about different options (PT again, PRP, surgery) and told me to come see him and compare my symptoms to the MRI. He pulled out previous xrays and took new ones. He compared everything and showed me. The bony growths were bigger. I could have PT and PRP and if they worked, I would have less pain and inflammation but the problem would still be there. He recommends surgery given my lifestyle. Honestly, I was excited he concluded this because I dont want to go through PRP, have my tendon wonderfully regenerated only to be rubbed into a tear again. I love to run, hike and bike; I dont want to give those up forever, but when walking around a grocery store causes me pain, I know I have to do something.

    He plans to go in from the rear, detach tendon, take care of the calcaneous and the tendon. Im told recovery will be equal to what everyone here has described for same surgical approach. Back to what I said initially, seeing that Jim is 61 and George is 63 and Im in id-50’s, I feel a strength that I too can do this and I’m not crazy for wanting to.

    I just hope I dont go crazy sitting around unable to do much. I was told by another friend who had this done to get a knee scooter to help mobility. I looking forward to getting out a little while recuperating.
    Thank you everyone for sharing your stories. I will post follow-up as I build my story.

  14. Kate

    Joe G. – if you can find a good Pilates teacher and once your surgeon clears you start going several times a week to strengthen your legs and core. The post surgery is such a boring pain for a runner but do not give in and decide to start up running because you are the toughest runner ever and can deal. You’ll just wreck the whole reason you took off for this surgery. Write off this year as far as running and find a different kind of a cardio to satisfy your need to workout. Once you are cleared for it … probably 4-5 months post surgery you can spin. Do HIIT and spin for cardio. Don’t run. Once you are finally cleared to “walk to run” program…. adhere to that… WALK to run. It’s not race. No racing for at least a year. ice and Night brace the foot to sleep. Soft shoes …. mules by Fitflop. Keep an eye on Gwen Jorgensen…. She just had the surgery and Nike has her in nice shoes with NO counter. Good luck.

  15. Ulrik Borch

    Thank you Stacy Høeg for this very interesting article. For me as someone who is recovering from haglund’s deformity this is very interesting!

    I have been dealing with heel pain for many years without giving it much thought. Not until this year where I started both running and walking a lot more, and the pain started preventing me from training…

    As the (business-side) cofounder of an exercise therapy app, I was fortunate to quickly consult a specialist doctor on our team. He recommended me to follow Injurymap’s program for pain in the back of the heel (https://www.injurymap.com/programs/achilles-tendon/pain_in_the_back_of_the_heel), to reduce running and walking to a minimum, until the pain had mellowed down, and also mentioned that I should avoid footwear that puts pressure on the heel.

    Now after nearly 3 months of training 30 minutes 3x per week, my heel is much stronger and more flexible, and I’m back to running quite decent lengths – longer than before. I still avoid walking and running long distances for many days in a row, in order to avoid a relapse.

    At the moment, my pain is barely there at all, and actually I’m more bothered by knee than my heel today… Still, I know I’ll be at great risk of developing Haglund’s Syndrome in the future, and that’s why I’m still looking for more information. I found this article while looking for examples of how to modify running shoes and soccer shoes. Didn’t expect to find such a breadth of information on this topic.

    A funny story… I told a former professional tennis player (played Davis Cup for Denmark for several years) about my condition. He then rolled up his socks and showed me quite large bumps on both heels. In spite of training professionally for years he never developed any pain. He told me that his physical coaches had often mentioned how strong and thick his Achilles tendon was, and for me that was (anecdotally) testament to how much a strong Achilles Tendon can do to prevent inflammation.

    Another recommendation… Was to use a custom-made insole that lifts up your heel around 2-3 cm / an inch (I believe to reduce pressure on the Achilles Tendon). This tip I got from a physician who himself suffers from Haglund’s Deformity. He told me that using such an insole has made it possible for him to continue playing tennis and exercising without being in excruciating pain afterwards. While it’s probably not suitable for long distance runners, it may help a lot of people who exercise 3-4 times a week or less? What are your thoughts on this Stacy Høeg?

  16. Drew

    I’ve had retrocalcaneal pain on both feet for the last 4 years. I have bumps on the backs of both heels, so I assume I have Haglund’s on both.

    Orthotics didn’t relieve the pain for long, so I’m now trying minimalism. When I wear shoes, I wear only Xero Shoes Prios or sandals now. But I’ve been doing more and more of my runs barefoot on pavement, and I’m finding that’s when my heels hurt the least. I ran barefoot for nearly for an hour two days ago, and the pain in the heels was easily tolerable the entire run and actually seemed to lessen as I went.

    I’m now at 4 months with the minimalist approach, and the the heel pain is improving steadily. I have almost no pain when I get out of bed in the morning now. So I’m cautiously optimistic.

    I don’t think I’ll ever go back to wearing heeled shoes, certainly not for running, and probably not for daily wear. I’ve noticed my posture has improved after wearing minimalist shoes or going barefoot for the last four months. My spine feels more vertically aligned, and standing for long periods is much easier than before. And my feet feel much stronger and more supple.

    Maybe the most pleasant surprise has been that I can actually run fast barefoot. I always assumed barefoot running was for slower runners who weren’t interested in running fast. But my experience the last few months has changed my thinking. Doing strides barefoot on my neighborhood synthetic track feels tremendous. The sense of freedom is exhilarating.


    I agree with you. I was put in orthotics for a very, very minimal plantar issue the start of one marathon season. Stupidly I just kept using them for years thinking they were helping me. And I wore shoes that had extra heel support. As described in my long Haglund’s “tale” above once I got the H’s surgery (both achilles 5 years apart.) I started back with minimal shoes, never returning to major heel support type shoes and absolutely never to orthotics. Instead I carefully choose my shoes during the season and will have 3 or so pairs going that I switch around during the weeks so as to never always use the same pair. These more minimal sole shoes make my feet muscles adapt and develop up the whole chain of muscles to my core stay strong. (I did find after wearing barefoot/very minimal sole type shoes all the time the first year after Haglund’s surgery that my knees needed more shock absorption) Here are my latest pairs that I like Spring/summer 2020: Nike Air Zoom Structure 22 (hadn’t worn Nike in ages and these are awesome right out of the box); Nike Zoom Fly 3 Men Running Shoes Hyper Violet/White/; Brooks Glycerine 17; Hoka One Clifton 3 (prob can’t find the 3 anymore). Of these I currently love most the Nike Air Zoom Structure 22…but I switch around a little bit so as to not always wear these. I feel it is key to get your shoes and socks off as soon as you are done with the run. Don’t leave the sweaty wet socks and shoes on, let your heels and achilles breathe and not swell up and get rubbed by salty sweaty socks binding around your ankle/heel (and let your shoes dry out too:)) Massage your feet at night and in the morning, get the blood flow into your feet and ankles and don’t forget we have a lot of special muscles and tendons in our feet that need attention and we often just forget them. Moji Foot Pro Massager and the Theraband foot roller are great to have on hand.

  18. roz

    Hi everyone – what a great post, thanks so much Tracy, and also to everyone who took the time to share experiences.

    I also suffer with Haglund’s, – I’ve probably had the heel bump since i was a teenager, as i’ve spotted one on my daughter’s heel, but it causes her no pain, and neither did mine until last year. overtraining and hill sprints caused the issue to flare up, and it took me a while to realise that the problem wasn’t my Achilles, but was haglund’s.

    i came across this article whilst searching for suitable running shoes, after inexpertly butchering all my expensive running shoes to poor effect!

    I don’t understand why there isn’t a shoe on the market to accomodate this condition. Surely removing a section of the heel of a normal running shoe and replacing it with a flexible but supportive mesh would be a feasible solution?

    Anyone have any thoughts on this before i spend a load of cash on making up a prototype lol!!

  19. Kate Mack

    There is. You don’t need to cut up shoes….Nike Zoom Fly 3 Running Shoes has no rigid counter – just the fabric. And Nike makes this style for men and for women. The men’s fit women also if you like their color more just have to convert woman’s size to mans. https://www.nike.com/t/zoom-fly-3-womens-running-shoe-FZRCxK/AT8241-304
    (Other stores sell these besides Nike) I’ve worn the men’s in my converted womens size and they are great.

    If you want proof that great runners wear this style — take a look — Gwen Jorgenson wears them :)

    1. Suzie from Boston

      Hi Kate
      I recently was diagnosed with hagludns deformity after going through 8 months of PT for my Achilles. My heel bump is pretty small and after the diagnosis my PT recommended that I use a heel lift and a callous pad over the bump. It protects it from rubbing! This was a miracle solution form me. It turns out that many hockey players get this too but call it “the Bauer bump” after the skate name. I have also been trying new shoes and new lacing strategies to keep my heel in place instead of rubbing. I have found that I have super narrow heels and this has caused much of my problems. I hope my suggestions help all who read this post. Going to order the. Ike zoom fly next. I have had luck with a cheap new balance tempo shoe and sized down 1/2 size to keep my foot in the shoe! Stay safe and keep your bump from growing!

      1. Kate Mack

        Hey Suzie – I love running along the Charles. Actually since I wrote about the Nike Zoom Fly 3 ….I have found another Nike shoe that I love even more – I bought 5 pair and switch them up daily so that the foam is fully refreshed and springy by the time I wear them again – It’s the Nike Zoom Pegasus Turbo 2. And it’s not like other Pegasus – these are totally diff than the rest of the Pegasus line. (I wore Brooks for years.) But this Pegasus Zoom Turbo 2 which came out in late 2019 is wonderful. You do need 2 pair so that you can change them out as they say the cushion on the Zoom type shoes needs a day or so to be ready to go again. But I really hope they keep making these or some like them as the back is fabric-only, no plastic heel counter and wonderful. They have great spring in them. https://www.nike.com/t/zoom-pegasus-turbo-2-womens-running-shoe-lBb48K/AT8242-009 They’re on sale now and may be disappearing soon. I wear a half size larger than my normal walking shoe and they fit well, roomy toe box.

        I used to always wear an orthotic but after my Haglunds removal surgery (on both feet) I wanted neutral shoes and to strengthen my foot and ankle muscles without a shoe holding my foot/leg in the proper alignment. I do careful strengthening of my entire body but very focused on lower back, hips, legs, ankles and YES feet…There’s a lot of muscles to strengthen and massage our feet.

        A side note …If you have to do Haglund’s foot surgery – listen to people who have gotten it – it’s no big deal, my opinion is why put it off? Haglund’s surgery is a very short, simple operation – make sure you get it done by an orthopedic surgeon who is trained in foot surgery. Go with someone who says they do a couple of these a month. It’s not complex like knee or hip or back surgery and people opt for knee and hip surgery all the time. Surgery for Haglund’s is simply opening up the foot at the base of the achilles tendon, detaching the achilles tendon if needed, removing & smoothing the boney bump on the calcaneous bone and debriding the achilles which is likely very agitated from excessive rubbing against the boney spur. The difficult part of Haglund’s is the patient being super cautious post-surgery. And this is difficult for runners. You cannot rush the healing process. The achilles is a thick, very hard tendon…it has to be left alone to heal. You cannot plan to run normally on it again for a year – hearing this and adhering to this is what is difficult – if you can’t stop running for 4 months to a year then don’t get the surgery as you will not heal properly. Having done this twice –yes mentally is was difficult — I could not compete or even run hard for a year after each surgery…. but now that it is all behind I am so relieved I got it….it was totally worth it, a blip on the screen of life. I have normal heel bones and achilles now and run long pain free daily. The key: Find a great surgeon who does plenty of Haglund’s removal surgeries and listen to them post surgery when they say “no running!” for at least 4 months post surgery and the next 8 months walk mostly run occasionally. Work with a trainer post surgery to re-strengthen body in particular feet, ankles calves ….

  20. roz

    thanks so much Kate, i’ll check them out. i did just buy the zoomfly SP fast as i thought it looked like ti had a fabric counter, but it is quite a rigid reinforced canvas and irritates – it also comes up quite high at the back. i’ll have a look at the 3.

  21. Clayton

    I am in my 20s and was born with bony heels, but not until this year have i developed pain in them. 7 months ago I had insertional achilles tendonitis, and could barely do any cardio for awhile. Got an x-ray and found I had a little bone growth in my right heel.Now, I’m able to do a lot of bike riding and walking, but still experience ankle stiffness, and random twinging pain in the heel area sometimes.Also, I think my walking gait is different because of how big the bump is. The back of the heel is still swollen and red/purple. I think the haglunds and bursitis has gotten bigger since ive been more active. I’m going to get an opinion on surgery because I don’t want this to be a problem for my achilles again down the road. Can anyone message me about how their recovery went from surgery? I’ve watched some people share their journey to recovery on youtube. Some people recover in a few months, and others take closer to a year.

  22. Joe Uhan


    If you’ve always had bony heels – and your pain is <1 year (with no change in "bony-ness") – I would think longer/harder (and get a second, non-surgical opinion) before doing surgery on this case.

    That it's:

    * relatively new (significant, actual Haglunds is typically years+)
    * has symptoms that could be other things (including neurogenic pain)

    means that it's likely another diagnosis, and an aggressive surgery like Haglund's would be an ineffective and expensive decision.

    1. Clayton

      Hi Joe, thank you for the advice. I am now responding to you 9 months after the injury, and I’m fully recovered. It took a diligent routine of rest and proper strengthening of eccentric calf raises and leg weight lifting to get rid of the pain and restore functionality. I’m so glad I didn’t get the surgery.

      I will always have the bony haglund’s, but I could care less anymore because it’s not causing me any pain anymore (fingers crossed I will stay pain free). This was the longest recovery period I have ever gone through from an injury. I can totally relate now with people who have gone through this.

      I hope none of you people in this forum have to experience this again, because this really did a toll on me mentally and physically. I had to get PT on the affected ankle on my achilles tendon after it healed because of how stiff my ankle had gotten and lost all ROM. This was causing hip and knee pain as well, but thank God I got that taken care of.

      In conclusion, it is very important for runners and athletes to have a strength training regimen as well as proper rest and flexibility so you do not go through a debilitating achilles injury. Trust me. I am glad Im fully recovered without surgery and you can do it too! Tough times don’t last, tough people do.

  23. George Ruiz

    Clayton – surgery to repair Haglunds is a serious surgery. However, you are young and it seems like you are catching this in it very early stages. The severity of the surgery depends on if the Achilles has to be detached to correct your bony heal. There are some procedures the surgeons can perform without detaching the Achilles, the recovery time is a fraction of the full on repair when the Achilles is detached in order to repair.

    Weight all your options carefully. I’m 17-months post surgery and doing well, but it was a long year of recovery and rehabilitation. Like any major surgical repair a minimum of a year is required for full recovery.

    1. Clayton

      Hi George, you were right, its all better now – I just had to be very patient and do a correct routine of rest and strengthening the tendon. This was the longest injury I’ve ever gone through. For full recovery for me, it was 9 months. 99% of my symptoms were gone at month 8 and by month 9 I was jumping, running, and lifting again with no problem. Thank you for your comment. I wish you a speedy recovery.

      To anyone in my shoes that is going through this bane of an injury, you have to be patient. Tendons take forever to heal because there is low blood supply and they have to be strengthened in a slow, progressive way. You also have to rest. The only way I would consider surgery is if your pain hasn’t improved after one year of true rest and physical therapy. I would highly recommend a licensed PT to aid you in your recovery. Even though I never did this, it probably would have lowered my recovery time by a month or so.

      1. George Ruiz

        Hi Clayton – I’m so glad to hear you are fully recovered and doing all that you love to do, pain free.
        I am as well running, jumping, skiing aggressively. I’m 18 months post surgery and was able to do most of these activities at 10-11 months. Patience is key to this recovery!

        Take care and keep in rolling!

  24. Stephen Matthews

    I have a cure. I developed serious haglunds deformity from over training and together with old ‘footballers’ ankle from my amateur days stopped me walking. 18 months off rowing (get some row coaching) the same distances has cured me – the rowing strengthens the soft tissue without body weight impact, improves posture and keeps the calorie burn – I can now run >20k without pain.

    1. roz witney

      thanks Stephen – also to anyone who suffers with this, the adidas boost trainer has a soft cut out back that has been brilliant for me – no pressure on the bony bit at the back of the heel :)

      1. Tracy Høeg

        Roz, I am the author of the article and just wanted to say thanks for the tip on the adidas boost. I am now finally running basically like normal and have been able to, for the most part, stop cutting our heels in my shoes, but am looking for a soft heel counter shoe so the problem doesn’t return. A bonus for me was my retrocalcaneal bursa ruptured and I have been running much faster since that time, and with less pain, since I can actually bend my ankle normally now that the swelling is almost completely gone. At this point I am glad I didn’t get the surgery.

  25. Kathryn McAllister

    Nike has also returned to making great shoes for those of us avoiding any hard plastic heel counter. My current favorites are the Nike Zoom Pegasus Turbo 2. (it has to be this exact model don’t get them mixed up with other Pegasus models) https://www.nike.com/t/zoom-pegasus-turbo-2-womens-running-shoe-lBb48K I was told to get more than one pair so that after a run it lets the foam reshape for 48 hours. So I have a couple of them that I alternate daily and run on trails (average 50 miles/week). Also switch out your socks. Don’t wear socks that hold sweat around the ankle go for taller socks. The Nike Multiplier sock if you can find them is awesome https://www.nike.com/t/multiplier-running-ankle-socks-2-pair-sJRRls/SX7556-916

  26. roz

    well thanks to YOU Tracy for a great article – there isn’t much quality info out there for folk who have suffered with this issue so it was a great find. Also it was nice at the time to find that i wasn’t the only one hacking the backs out of my expensive trainers lol!!

  27. Thomas Moller

    In the summer of 2018 I was feeling pain in both my achilles after running.
    When things didn´t get better, I got fysioterapy including shockwave. That didn´t help either, so in August 2020 I contacted Bispebjerg hospital in Copenhagen, who specialises in athletes injuries.
    After a scan I was diagnosed with Haglunds syndrome in both legs.
    My training program from september 2020 is slow and heavy weight heel lifting from a flat floor.
    The first 12 weeks was 3 times a week starting with 3 x 15 ending with 3 x 6 with heavy load.
    The progress was acceptable and the next scan showed inprovement.
    I was then told to flex a bit more in the heel lift, but that was perhaps to soon, because the pain came back.
    Now I have gone back to flat floor, and things are getting better.
    My next scan will be ultimo february 2021.

    1. Joe Uhan


      I would strongly encourage you to consider that your ankle pain may actually be ***neurogenic***.

      First, consult this: https://www.irunfar.com/2017/08/six-signs-that-your-running-injury-is-nerve-pain.html

      * Haglunds – when the pain is ***truly*** from bony overgrowth is seldom bilateral at the exact same time
      * conversely, neurogenic pain (say, from L5-S1 nerve level) is commonly bilateral

      Thirdly: neurogenic pain is impervious to all the above treatments you’ve tried

      Fourth, consult this: https://www.irunfar.com/2019/02/a-sticky-situation-identifying-and-treating-nerve-pain-in-runners.html

      If you have significant nerve tension with the Sump Test (“very tight hamstring” and/or you feel much tension in calves), I would suspect you have neurogenic heel pain and thus require neurogenic treatment for this issue.

      (See comments of Six Signs article for resources).

      Good luck,

  28. Thomas Møller

    Hi Joe.

    Thank you for your reply.

    I have read your articles, and find them interesting.

    I could relate to the following:

    Occasional sharp, shooting pain
    No palpable tendon soreness
    Pain at rest

    Throughout the last 2 years I have experienced (i 3 ocassions) and uncontrollable “impulse” over my left knee. It was like the muscle/nerve had its own life. It lasted about 3-5 minutes with intervals.

    I don´t know whether it can relate to my achilles.
    My symptoms are a general irritation, mostly in rest.
    I have very little morning stifness, but I havent been running for 5 months. I have only done my exercises three times a week, combined with a general strenght
    training at a fitness center.

  29. Rich


    This is a fantastic article :)

    It’s been interesting hearing everyone’s problems, like mine with my shoes wearing away in no time and my heel hurting all the time! Just recently I’ve come up with a very simple solution and it’s great.

    I have a large bump on the left (outside) part of the back of my left heel. I’ve been putting tape on the left side of my left shoe to reduce rubbing and the shoe wearing away. This has been partially successful.

    Why does my bump hurt. Pressure. It’s taking all the force at the back of the heel. So instead I did the OPPOSITE and built up the right side of the back of my heel. Bingo, obviously! So now the force is spread over the whole of the back of my heel.

    So I use tape and a large deep pad (a rolled up corn plaster or a few sticky pads on top of each other). I’d post a pic if I could.

    The other alternative which works just as well is to stick the pads ON MY FOOT on the opposite side. It’s the same idea. It’s quicker than putting it on the shoe, but you have to keep reapplying it = naff. Adding to the shoe is long term easier except you have to do it to all your shoes.

    Well worth the 10 mins and $10. No pain, no operations and no damaged tendons from surgery. The plasticectomy on the my shoe, not the operation on me :)

    I’ve finally put my engineering degree to a good use

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