Not everyone with a diagnosis of Haglund’s deformity will benefit from doing exercises. In this article, sports physio Maryke Louw explains what exercises to avoid (in all cases), what exercises might be useful, and at what stage of the treatment process to start them. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.
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If Haglund’s deformity is being blamed for your heel pain, exercises should not be included too early in the treatment process; they will just make things worse. The most important part of treatment is to reduce the strain on the injured area so it can calm down. You can find a detailed discussion on how to do that here.
❌Avoid exercises that stretch your calf and Achilles
I realise that this advice is contrary to a lot of the popular exercise advice you find when you google Haglund’s deformity, but let me explain.
Stretching your calf and Achilles tendon involves moving your toes closer to your shin (into dorsiflexion). This movement pulls the Achilles tendon tighter across the heel bone, increasing the compression and strain in the back of your heel.
This is a normal action, and usually it doesn’t cause any problems. However, when you have an injury in that area, this normal compression can irritate it and increase your pain (similar to prodding a bruise).
A Haglund’s deformity further increases the amount of compression you experience in this dorsiflexed position, because it decreases the space between the Achilles tendon and the heel bone.
👉So, to allow your heel pain to settle down and recover, you want to temporarily avoid all exercises that move your ankle into a strong dorsiflexion (toes closer to shin) stretch position.
Examples include:
Standing calf stretch or knee-to-wall stretch
Putting a band around your foot and pulling your toes towards you
Deep squats with your heels flat on the floor
Downward dog in Yoga
Dropping your heels over the side of a step
✅You can gradually restart all of these activities once you’ve recovered.
A physiotherapist can help you figure out how to adapt your daily activities to help your heel pain to calm down.
Strength training exercises for Haglund’s deformity
When to use strengthening exercises
The structures around your heel that show up as injured on scans when you get diagnosed with Haglund’s deformity are the Achilles tendon (insertional Achilles tendonitis) and/or the heel bursa (bursitis).
If you have Achilles tendonitis (with or without bursitis) you will likely have to add in strength training exercises to help restore the tendon’s strength and function.
If it’s only your bursa that is injured, you likely don’t have to do any strength exercises, because the tendon’s structure and strength are not affected. An exception is when you’ve had your bursitis for a long time and this has caused you to lose a lot of strength in your leg; then you may have to do exercises to help for that.
👉Follow these links for a detailed discussion of all the evidence-based treatments for Achilles tendonitis and heel bursitis.
What exercises to do
Calf raises are a great option for strengthening the Achilles tendon and calf. And you can easily adapt them so they don’t cause extra strain and compression on the back of your heel.
Early-stage calf raises
At this point, we want to get some movement going but really avoid causing compression and stretch over the back of the heel.
Ways to do this include doing your calf raises:
On two legs – so, it is a relatively low load
At floor level (as opposed to over the side of a step) – this helps to reduce the amount of dorsiflexion
Wearing shoes or sandals that have a heel – this reduces dorsiflexion even more, as it stops your heel going all the way flat to the floor and protects the ball of your foot from the hard floor.
Instructions
Stand with your feet about hip distance apart and hold on to something sturdy.
Go up on your toes.
Pause for a second.
Come back down slowly.
Don’t turn your feet to the outside or inside – your weight should be evenly distributed along the ball of each foot, from your big toe to your little toe.
How many
As many as you feel comfortable with, once a day.
Aim to eventually get to three sets of 20 each with a minute’s rest between sets.
You can also spread it out so that you do 1 set of 20 in the morning, afternoon, and evening.
💡 Top tips
Don’t go all the way up if that feels uncomfortable.
If you need your heels raised even more, use a folded towel under your heels, or you could get some shoe inserts (heel wedges) to raise your heels a bit.
Later-stage calf raises
To regain full strength, you do eventually have to move on to heavier calf raises (i.e. by adding weights or doing them on one leg), but don’t rush it.
👉Making the transition gradually (over a period of 12 to 24 weeks) usually works best.
I find that my patients do better if we build good strength first in positions that limit the amount of dorsiflexion (so, stick to floor level) before we then start doing these exercises in more challenging positions (like over a step). For some people we never move to doing them over a step – not everyone needs to.
Also, what positions you train in and how heavy the weights are will depend on your specific activity goals. The rehab plan for someone who wants to get back to sport will look very different from that of someone who just wants to get back to walking and normal daily activities.
How we can help
Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
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