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Haglunds? Achilles options for triathletes.
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Hi. It seems like most of the discussion about Haglund's (besides Gwen's) is several years old. Hoping I can get some information.

I am a triathlete - sprint, Olympic, 70.3 - age-group World Champion caliber. Female, age 52. I've been patching together running for the last 3 years but finally couldn't run through the pain anymore in my right achilles. Almost no pain swimming and biking; just running. MRI and X-ray show small Haglund's deformity, moderate tendinosis, low grade tears, moderate bursitis. My local ortho surgeon is not entirely encouraging that surgery will make a difference. PRP injection had no effect and was one of the most painful experiences of my life.

I've turned to bike racing this summer as I don't want to have surgery while the sun shines in Oregon, but I'm seriously considering it for the fall. I'm not sure if I should get another opinion, have the surgery or if there are other unexplored options. I am speaking to a different ortho guy next week about injection options. I have such PTSD after the PRP injection that I am very dubious about more injections.

I will take all advice. I would really like to get back to racing triathlon in 2020. Thanks.
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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Is the diagnosis that the small Haglund's deformity is definitely the cause of the problem? It sounds like it is with the bursitis. But the pain is in the right area for that?

What kind of physio are you doing?

Haglund's isn't the cause of my Achilles problem. If it was I'd try and find an Adidas running shoe I liked. They have a brilliant design in the heel area so the part of the shoe directly behind the Achilles should be softer than any shoe I can think of.
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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Are you left handed? If so I may have some suggestions for you.
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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 I have Haglunds on my right heel and most shoes I wear a hole thru the fabric and into the plastic and get blisters on my heel. For shoes try Saucony freedom Iso. Around the heel its all fabric, and so far they have been the only running shoes that have worked for me.
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Re: Haglunds? Achilles options for triathletes. [J7] [ In reply to ]
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Right handed
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Re: Haglunds? Achilles options for triathletes. [timc267] [ In reply to ]
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I don't think finding the right running shoes is currently the solution, although I appreciate the input for the long run. I've tried several different pairs and cut out the back of others. Rubbing doesn't cause aggravation as much as impact in general.
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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Alright, I’ll bite. I had exactly the same symptoms. Ran on it for a year before I couldn’t stand it anymore. Had the operation in 2013. I did it in Munich and they refused to detach the tendon but went under it instead. I’ll tell you that it’s still iffy (particularly in the morning and after slow runs); it has good days and really bad days, and I’ve had to cycle through different orthotics etc to try to manage it. That said, I’ve smashed a lot of my tris since then, and just had a successful day at Steelhead, though my marathoning days are certainly over. While sometimes when it’s acting up I wonder if it was the right choice, I feel better knowing that it isn’t torn anymore and won’t (probably) rupture. You can message me if you have any questions.

The only way to avoid disappointment is to not try anything at all.
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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I dealt with achilles issues for 3 years. When I say dealt I mean there was no working around it for 3 years it hurt every single day to get out of bed and walk. On my best days during that time I could walk 3 miles with my dog. It was terrible. I did everything from PRP to contrast baths to rolling out and doing everything I could possible think of. I saw specialist after specialist and nothing improved. I did eccentrics for 2 years and nothing changed. THEN, yep that is the cool part THEN I was doing research, like I did every night during those 3 years, and found this lady Karin Grävare Silbernage. I emailed her and we set up a phone consult. She was amazing. I had sent her my notes and therapies and exercises and this is what she said. Granted everyone is different so I don't know your exact story. "You have a short soleus it is not good or bad it is just the way you were made. Stop doing the eccentrics off of a stair and just do them on flat ground. Eventually, when all pain has gone away(she meant to the touch and jogging) then you can do them off of a stair. I did this among some other rehab stuff that was very subtle. The big game changer with this is I did dry needling with it. Not acupuncture I had done that for 4 months weekly and didn't change. Dry needling where they went in and poked around the needle got stuck and the muscle contracted and bent it, so painful more so than the PRP. That night I couldn't walk. The next day I walked without pain. I did dry needling weekly for 4 months. It hurt like hell every single time but then things turned!!!!!

In 3 weeks I was improving. In 6 weeks I was jogging(hadn't done that in 3 years) for 15 minutes. At 4 months I did a sprint triathlon. This year I have done 2 Olys and a trail race. My run times are faster prior to being injured. I run whenever I want volume/intensity aren't limiters.

That is my .02
Last edited by: lonniecdams: Jul 2, 19 15:55
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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I would suggest seeing a sports podiatrist/foot & ankle surgeon as most orthos don't deal with it much. I had Haglunds surgery with a really great sports podiatrist who has done the surgery many times, including on numerous national level athletes. He's also a triathlete himself. I know of multiple success stories of people who returned to running at their prior level after this surgery but it does take significant time.


I had surgery almost 6 months ago. I had managed a flare up a few years ago with extracorporeal shockwave therapy which seemed to heal the tendon and resolved the inflammation. I stopped running for several months while I was waiting fort the shockwave to work its magic. It resolved 100%. I then enjoyed an 18 month streak of excellent running and training. February 2018, seemingly out of the blue, my heel flared up again. I tried everything including multiple rounds of shockwave and many months off running. Nothing helped and by December I couldn't even go for a long walk without it hurting. Recovery from surgery is going great but it is a very long road. I had surgery in January and I am just starting to slowly jog outside after weeks on the Alter G. I've been told to expect it to take a year from surgery before things will feel normal. I do however think I am going to get back to 100% based on well I have healed so far. Even if I don't I'm at peace with it as I really could not run or even walk especially well by the time I had the surgery. I pretty much had nothing to lose by doing it. A few things to bear in mind. People call any kind of bony protrusion on the heel a Haglunds deformity but there is a difference between having a "true" Halglunds deformity that you are born with where the top of the heel bone is pointed and sticks out (what I had and Galen Rupp also, I believe) and having a bone spur near the insertion (what Gwen had) that has developed more recently. The surgical options can be quite different. In my case, the surgeon had to vertically split my tendon to resect the bone. Galen Rupp had his tendon fully detached and bone resected. Gwen's surgeon did not have to cut or detach her tendon so her recovery time is expected to be MUCH quicker, i.e. running within a couple of months. You need to know exactly what the situation is for your heel and what the exact procedure you will be looking at is before you can think about recovery timelines.

If you have not tried shockwave yet, I would suggest that first. You could do that over the summer and see if it works. There is good clinical data that supports it but it will take a longish time to work (12-20 weeks). Be very cautious of eccentric heel drops for this condition. They may help you if the issue is more to do with a degenerated tendon but they also may make it worse as you may just be causing the tendon to rub more on the bony protrusion. It sort of depends what your exact issue is.
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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jbthochman wrote:
Hi. It seems like most of the discussion about Haglund's (besides Gwen's) is several years old. Hoping I can get some information.

I am a triathlete - sprint, Olympic, 70.3 - age-group World Champion caliber. Female, age 52. I've been patching together running for the last 3 years but finally couldn't run through the pain anymore in my right achilles. Almost no pain swimming and biking; just running. MRI and X-ray show small Haglund's deformity, moderate tendinosis, low grade tears, moderate bursitis. My local ortho surgeon is not entirely encouraging that surgery will make a difference. PRP injection had no effect and was one of the most painful experiences of my life.

I've turned to bike racing this summer as I don't want to have surgery while the sun shines in Oregon, but I'm seriously considering it for the fall. I'm not sure if I should get another opinion, have the surgery or if there are other unexplored options. I am speaking to a different ortho guy next week about injection options. I have such PTSD after the PRP injection that I am very dubious about more injections.

I will take all advice. I would really like to get back to racing triathlon in 2020. Thanks.


Where exactly is your pain? Is it the actual achilles tendon or the bump beside it? Just because the MRI says you have tendinosis does not mean that is your actual problem. I had high hamstring tendonopathy on the right. MRI showed tendinosis of both of my hamstring tendons. To this day (knock on wood), I've never had a hamstring problem on the left. So, it just goes to show you that a lot of us athletes would most likely show up as some type of tendon inflammation when scanned. You or your doc need to localize this to either the Haglund's deformity, the achilles, or both. Grab the achilles tendon between your fingers. Is it very sore when squeezed? Compared to the other achilles? Is the right achilles swollen in comparison to the left achilles?
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Re: Haglunds? Achilles options for triathletes. [J7] [ In reply to ]
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I'm intrigued by your question. Is the idea that we sometimes push off on our non-favored leg and that extra force isn't helping? So would the suggestion to deliberately do the opposite?

Coincidentally I was running a few days ago and altered my stride length to fit in a few curbs and it occurred to me at the time that I was doing it by bounding a bit off my most injury prone side each time.
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Re: Haglunds? Achilles options for triathletes. [jbthochman] [ In reply to ]
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A former Canadian figure skater turned podiatrist recommended a simple cure that worked for me (bothered only on run). Anti inflammatory topical gel (diclofenac) to ease the pain (took a few days as I remember correctly) And once subsided, used a foam pad cut out (custom) to the shape of my heel where I had an indentation just below the prominent bony part of heel. Go to drug store and either find small foam pad or double or triple up moleskins and apply to your heel. (3 inches long, several mms wide and deep)If it works like mine did, then just attach To inside of shoe heelsjust adjacent to sole inserts. That way you don't have to apply to your heel evertime, but will be a shoe insert of sorts.

Basically it kept my the lowest part of heel from pressing sharply against the heel of shoe, calming the bone or bursa.

The minute I took off my shoe she said Haglund deformity, but did take quick X-ray. I loved tight shoes and skates in my youth...led to Haglund and Morton's neuroma. Wider toe box helped Morton's, no surgery and this simple solution from former skater has worked great for last 3 years or so. Lucky I got her for treatment, she had first hand knowledge.

Found this helpful. http://www.heelandarchpainclinic.com.au/haglunds_syndrome.html

Good luck. Hope it made sense.
Last edited by: tyrod1: Jul 3, 19 15:00
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