Haglund’s Deformity is a condition affecting the back of the heel, manifesting as a noticeable bony prominence on the heel bone, or calcaneus. This enlargement is often called a “pump bump” due to its frequent association with irritation from the rigid backs of certain shoes. The deformity can lead to painful symptoms, collectively known as Haglund’s Syndrome, which includes inflammation of nearby soft tissues. People often wonder if this persistent bump and associated discomfort will disappear on their own.
The Nature of Haglund’s Deformity and Spontaneous Resolution
The deformity is a structural alteration of the heel bone, specifically an enlargement of the superior-posterior aspect of the calcaneus, medically termed a retrocalcaneal exostosis. This bony growth is a permanent change to the skeletal architecture, not temporary swelling. Since the underlying issue is excess bone tissue, the deformity will not spontaneously resolve or shrink through non-invasive means.
The bony prominence creates a mechanical conflict, rubbing against the Achilles tendon and irritating the retrocalcaneal bursa. This fluid-filled sac, situated between the tendon and the bone, often becomes inflamed and painful (bursitis). The enlargement can also cause irritation and degenerative wear on the Achilles tendon, known as insertional Achilles tendinopathy.
Symptoms like pain and swelling often fluctuate, leading people to believe the condition is improving. When irritation from footwear is removed, the secondary inflammation may subside, relieving pain. However, the mechanical source—the bony prominence—remains unchanged and will cause symptoms again upon re-exposure to friction. Inherited foot structures, such as a high arch or a tight Achilles tendon, can predispose individuals to this condition.
Conservative Strategies for Symptom Relief
Since the bony prominence is permanent without surgery, the initial focus of treatment is on reducing resulting pain and soft tissue inflammation. Conservative management aims to control symptoms like bursitis and tendinopathy by reducing mechanical friction on the heel. These non-surgical approaches are often successful in providing long-term relief.
One effective strategy involves modifying footwear to eliminate pressure on the prominent area. Patients should avoid shoes with rigid heel counters and instead wear open-backed shoes or those made with soft materials. Inside the shoe, soft heel pads or lifts can slightly elevate the heel, reducing tension on the Achilles tendon and shifting contact away from the bone.
Controlling inflammation is another goal, typically achieved through rest and applying ice. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to temporarily reduce pain and swelling. For severe inflammation that does not respond to initial measures, a physician may consider a cortisone injection to target the inflamed bursa.
Physical therapy and specific exercises are also important components of symptom management. Stretching the calf muscles and Achilles tendon helps increase flexibility, which is beneficial because a tight Achilles tendon is a common contributing factor to the deformity’s irritation. Strengthening exercises for the muscles around the ankle can also provide better support and reduce the overall strain on the heel. Custom orthotic inserts may be prescribed to address underlying biomechanical issues.
When Surgical Intervention is Necessary
When conservative treatments fail to provide adequate symptom relief, surgical intervention becomes the definitive solution. Surgery is the only method that can physically remove the bony enlargement, permanently eliminating the mechanical source of irritation. A common criterion for considering surgery is the persistence of severe symptoms after a dedicated non-surgical treatment period, often lasting six to twelve months.
The procedure typically involves the careful removal of the prominent portion of the calcaneus to create more space between the heel bone and the Achilles tendon. This is often referred to as a Haglund’s excision. If the Achilles tendon has sustained damage from chronic irritation, the surgeon may clean up the tendon or, in severe cases, reattach it to the bone after the spur is removed.
Post-operative recovery can be lengthy due to the sensitive nature of the Achilles tendon insertion. Patients are usually non-weight bearing for two to three weeks, often in a splint or cast. Progression to full weight-bearing in a walking boot with heel wedges takes several weeks, and physical therapy is started early to regain motion and strength. Full recovery and a return to high-impact activities may take six months to a year, but most patients experience significant pain relief after healing.