All About Haglund's Deformity - DOC

All About Haglund’s Deformity


What Is Haglund’s Deformity? 

Also known as Haglund’s Deformity (or “pump bumps”), heel bumps are a bone enlargement on the back of the heel bone. These usually occur for athletes when the shoes they wear rub up against the heel, and they can be aggravated by the height or stitching of a heel counter of a particular shoe. The result is a painful bump or bumps on the heel that make exercising very difficult. Another term used for this condition is pump bump because it can frequently occur with wearing high heels as well.   

Haglund’s deformity is a large bump at the back of the heel where the Achilles tendon attaches to the heel bone. It also referred to as Haglund’s disease (but it isn’t really a disease). It is sometimes called a “pump bump” due to its association with shoe irritation. In short, it is a painful bony bump that often develops bursitis, or inflammation of the little fluid-filled sack (the bursa) between the heel bone and the Achilles tendon. If bursitis (inflammation of the bursa) develops, it can become even more painful. 

When most people first notice Haglund’s deformity, it is because the skin, bursa and other soft tissues at the back of the heel gets  irritated as the knot of bone rubs against the heel counter in shoes. As explained, Haglund’s disease is also referred to as a “pump bump.” This is mainly because the rigid heel of pumps can create friction and pressure that will aggravate the bony enlargement as you walk. Although men and women both develop Haglund’s deformity, it is seen in women who wear pumps most frequently. 

Symptoms of Haglund’s Deformity

Pump bumps (or Haglund’s deformity) can develop in one foot or in both feet. You might have Haglund’s if you notice any of the following symptoms: 

•You have pain or tenderness at the back of the heel where the Achille’s tendon attaches. 

•Have swelling near the attachment of the tendon to the heel bone.  

•You have noticed a slowly growing bump on the back of the heel. 

•The back of the heel turns red after getting rubbed in shoes. 

•The back of the heel hurts worse when you run or wear high heels. 

What Causes Haglund’s Disease? 

For the most part, Haglund’s deformity is genetic.  You develop it by inheriting a foot type that is prone to the mechanical irritation that leads to the problem.  If you have this particular foot type and wear shoes that rub and irritate the back of the heel bone (calcaneus) where the Achilles tendon attaches, then you are even more likely to develop it. The contributing factors include a supinated foot type, a heel bone with a prominence (or pointed shape that stick out toward the tendon) at the back, a tight Achilles tendon (referred to as Equinus by doctors), and a high arch. All of these factors simply make it more likely that the back of the heel will press against the shoe and rub. As the tendon gets rubbed the wrong way, the bursa starts to develop and fill with fluid. This response is really your body’s way of protecting the tendon from damage, but it backfires. The friction from all that rubbing causes the bursa to become inflamed and swell. This causes the bump to become red, hot and stick out even further. Much like a sore thumb, it then gets irritated by even the softest shoes.

Diagnosis of Haglund’s Deformity

When you suspect you have pump bumps or Haglund’s Deformity, your foot doctor will begin by taking a complete history of the condition. A physical exam will also be performed. X-rays are usually taken on the first visit as well to determine the shape of the heel bone, joint alignment in the rearfoot, and to look for calcium deposits in the Achilles tendon. The history, exam and x-rays may sufficient for your foot surgeon to get an idea of the treatment that will be required. In some cases, it may be necessary to get an ultrasound or MRI to further evaluate the Achilles tendon or bursa.  While calcium deposits can show up on xray, the inflammation in the tendon and bursa will show up much better on ultrasound and MRI. The results of these tests can usually be explained on the first visit. You can then have a full understanding of how the problem started, what you can do to treat prevent it from getting worse/ You will also know which treatment will be most helpful in making your heel pain go away.   


Treatment of Haglund’s Deformity: 

Non-surgical Treatments 

Surgery should always be the last option. We believe that biologic treatments that preserve normal anatomy are very helpful, particularly for runner, athletes, and active professionals with buy schedules. All non-surgical approaches attempt to calm down the inflammation of the bursa and Achilles tendon. They do not address the bony bump, but they can substantially reduce and shrink the inflamed soft tissue. 

Some non-surgical treatments include: 

Oral Anti-inflammatory Medications. NSAID’s (non-steroidal anti-inflammatory medications) such as Motrin, Aleve, and Steroids (like prednisone) may help control the pain and stop the inflammation.

Topical Anti-inflammatory Medications. NSAID’s in cream or lotion form may be applied directly to the inflamed area. With these, there is no concern for stomach upset or other problems associated with oral medication.  

Ice. Ice can applied be applied right to the red, inflamed area and help calm it down. Try applying a podiatrist-approved ice pack to the affected area for 20 minutes of each hour. Just make sure you don’t put ice directly against the skin. 

Exercises. Stretching exercises may relieve some of the tension in the Achilles tendon that started the problem. If you have Equinus Deformity (or a tight heel cord) this is critical to prevent it from coming back again. 

Heel lifts. Heel lifts placed inside the shoe can decrease the pressure on the Achilles tendon. Remember, pressure and friction cause the bump to become inflamed.   

Heel pads. Placing gel padding to cushion the Achilles tendon (at the back of the heel) can also help reduce irritation from shoes. 

Shoe modification. Wearing open-backed shoes, or shoes that have soft backs. This will also help stop the irritation. 

Physical therapy. Physical therapy, such as ultrasound, massage and stretching can all reduce the inflammation without surgery.

Orthotic devices. Custom arch supports known as foot orthotics control abnormal motion in the foot that can allow the heel to tilt over and rub against the heel counter. Orthotics can decrease symptoms and help prevent it from happening again.  

Immobilization. In some cases, a walking cast boot or plaster/fiberglass cast is necessary to take pressure off the bursa and tendon, while allowing the area to calm down and heal.  

When Is Surgery Needed? 

Only if non-surgical attempts at treatment fail, will it make sense to consider surgery. Surgery for Haglund’s can include many different procedures. Some of these include removal of the bursa, removing any excess bone at the back of the heel (calcaneal exostectomy), and occasionally detachment and re-attachment of the Achilles tendon. If the foot structure and shape of the heel bone is a primary cause of the Haglund’s, surgery to re-align the heel bone (calcaneal osteotomy) may be considered. Regardless of which exact surgery is planned, the goal is always to decrease pain and correct the deformity. The idea is to get you back to the activities that you really enjoy. Your foot and ankle surgeon will determine the exact surgical procedure that is most likely to correct the problem in your case. But if you have to have surgery, you can work together to develop a plan that will help assure success.  

Prevention of Haglund’s Deformity

Once your pain and inflammation is gone, you can prevent Haglund’s deformity by: 

•Wearing the best shoes for your foot type. You should high-heels and pumps if possible. 

•Wear orthotics (custom arch supports) or over-the-counter orthotic devices 

•Perform frequent Achilles tendon stretching exercises to prevent it from becoming tight agian 

•Avoiding running uphill when training. Try to run on softer surfaces and avoid concrete.