Haglund deformity due to tight shoes

EDITORIAL

Thursday, 6 May

Björn "Dr 8a" Alber talks about the problem with tight shoes and explains Haglund deformity which his son, who is a World Cup boulderer, has faced for some years.

"In the plus 30 years, I have climbed and coached climbers, climbing shoes have had a tremendous development. Common for all is that they get snugger and proportionally smaller compared to the foot's actual volume and size. The drawback is damaged feet! In the early days, it was limited to deformity of the toes eg Hallux Valgus- sharp inward angling of the big toe- sometimes leading to corrective surgery.

Haglund's deformity, which was first described in 1927, is a new (for climbers) and more sinister deformity. It involves the abnormal growth and following soft tissue changes around the Calcaneal insertion of the Achilles tendon (see picture) the top end of the Calcaneal bone grows a bone spur which in turn – by the pressure of the shoe- irritate the soft tissue above (the Achilles tendon thickens, an inflammatory response will develop in the tendon as well as in the ”bursa” between the tendon and the bone). The result is an extremely painful condition that will make it almost impossible for the athlete to wear his “competition” shoes, and perform heel-hooks etc.

The rigidity and size of the shoe is the main problem but some external factors will contribute:
It is more common in females than in males – softer tissue due to estrogen
High arc of the foot predisposes
Tight Achilles tendon predisposes
Protruding (extending back from the heel) Calcaneus bone- with sharp angles predisposes

While this condition was first predominantly seen in middle-aged females (high heels) it will be more troublesome when developing in young athletes because between 11-19 years of age the great growth spurt will make for a greater deformity. For the climber – especially a young one- the best plan is to limit the use of extreme, aggressive shoes! (This is just as important for Soccer and Hockey players that get to stiff shoes at an early age).

The cure of this condition is;
Stop using aggressive tight shoes- a period of no climbing might be necessary
Get help from a physiotherapist with stretching of the Achilles tendon
Use anti-inflammatory drugs, gel and/or pills
Get local steroid injection (should be done by specialists)
When starting to climb harder again use larger shoe and have an orthopaedic technician make an inlay to take the stress of these structure- see picture.
If this fails surgery should be performed!

In this picture, you see the heel of a top Swedish athlete where the above strategies have failed. The surgery (Surgical excision by lateral approach) should take away a sufficient part of the superfluous bone, which in turn will involve up to 6 months before returning to hard climbing! Since the deformity is most often bilateral a 12-month period of no climbing can be expected. Needless to say, the best strategy is to avoid getting this condition at all question the use of extreme shoes in young athletes! Be observant and take preventive measures in time!"

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