Haglund’s deformity, often called “pump bump,” is a common condition causing heel pain. It can cause discomfort and limit activity. This article explores whether Haglund’s deformity can resolve without surgery and discusses various management approaches.
Understanding Haglund’s Deformity
Haglund’s deformity is a bony growth on the heel bone where the Achilles tendon attaches. This enlargement appears as a noticeable bump on the back of the heel. It is often called “pump bump” because rigid-backed shoes, such as high heels or men’s dress shoes, can aggravate the area.
The deformity can irritate surrounding soft tissues, including the Achilles tendon and the bursa, a fluid-filled sac located between the tendon and the bone. When the bursa becomes inflamed, it is known as retrocalcaneal bursitis, causing pain, swelling, and redness at the back of the heel. While the exact cause is not fully known, factors such as tight Achilles tendons, high arches, certain gait patterns, and genetic predisposition may play a role.
Non-Surgical Paths to Relief
Many individuals with Haglund’s deformity experience significant improvement through non-surgical methods, particularly when addressed early. These conservative approaches aim to reduce inflammation and pressure on the affected area, allowing the body to heal. While these treatments cannot shrink the bony protrusion itself, they effectively manage the associated pain and inflammation.
Common non-surgical treatments include:
Rest and activity modification to alleviate stress on the heel.
Applying ice to the inflamed area for 15-20 minutes several times a day to reduce swelling and pain.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help manage discomfort.
Stretching exercises, especially for the Achilles tendon, to reduce tension around the heel.
Shoe modifications, including wearing open-back shoes or those with soft, flexible backs, or using heel lifts or pads to reduce friction and pressure.
Physical therapy, which can provide structured exercise programs and modalities like ultrasound to reduce inflammation.
Corticosteroid injections into the bursa for relief, though direct injection into the Achilles tendon is generally avoided due to potential risks like tendon weakening.
Surgical Intervention for Haglund’s
Surgery for Haglund’s deformity is typically considered only after a significant period of conservative treatments, usually six months or more, have failed to provide adequate relief. The primary goals of surgical intervention are to remove the bony prominence, address any inflamed bursa, and repair or debride the Achilles tendon if it has been damaged.
Surgical procedures might include removing the prominent bone directly or, in some cases, a calcaneal osteotomy, which involves reshaping the heel bone. If the Achilles tendon is significantly damaged or degenerated, the surgeon may remove the affected portion and reattach the healthy tendon to the bone using anchors. Recovery generally involves a period of immobilization, often in a splint or boot, followed by physical therapy to restore mobility and strength. Patients may be non-weight bearing for several weeks, with a gradual return to full activity.
Long-Term Outlook and Prevention
With appropriate treatment, whether conservative or surgical, most individuals with Haglund’s deformity experience significant improvement. While the bony bump may remain without surgical removal, effective pain and inflammation management allows many to live comfortably. The potential for recurrence exists if contributing factors, such as ill-fitting footwear or tight tendons, are not continuously managed.
Preventing recurrence or initial development of Haglund’s deformity involves:
Wearing shoes with soft, flexible backs or open backs to avoid pressure on the heel.
Regularly stretching the Achilles tendon to maintain flexibility and reduce tension.
Using orthotic devices or arch supports for high arches to help properly align the foot and reduce irritation.
Gradually increasing activity levels, especially in sports, to help prevent overuse injuries that might contribute to the condition.