Haglund’s deformity, often known as “pump bump,” is a foot condition involving a bony enlargement on the back of the heel. This abnormality can lead to significant pain and inflammation. The condition is characterized by a prominent bony growth that creates friction against footwear, particularly shoes with a rigid back. While the pain can be managed effectively, the structural issue itself does not resolve on its own.
Defining the Anatomy and Symptoms
Haglund’s deformity is a structural abnormality of the calcaneus, or heel bone, where a bony prominence forms near the insertion of the Achilles tendon. This bony outgrowth irritates the surrounding soft tissues, especially the retrocalcaneal bursa. The bursa is a small, fluid-filled sac that cushions the Achilles tendon and the heel bone. Constant friction causes the bursa to become inflamed and swollen, a painful condition known as retrocalcaneal bursitis.
Symptoms include a visible bump on the back of the heel, localized pain, and swelling. The pain is often aggravated by wearing footwear with a stiff heel counter, which presses directly against the bony enlargement. Inherited foot structures, such as a high arch or a tight Achilles tendon, can predispose an individual to this deformity. The condition is frequently linked to external factors, like rigid-backed shoes, which trigger the irritation.
Non-Surgical Management for Pain Relief
The initial approach focuses on managing inflammation and pain, rather than altering the bony structure. The simplest measure is modifying footwear by avoiding shoes with rigid backs, such as high heels, to reduce friction on the heel. Open-backed shoes, sandals, or footwear with soft heel counters are recommended to alleviate external pressure.
Conservative treatment often includes the RICE protocol: resting the affected heel and applying ice to the inflamed area several times a day to reduce swelling. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used to decrease pain and inflammation. These medications provide symptomatic relief but do not address the underlying bony protrusion.
Physical therapy focuses on stretching exercises for the Achilles tendon and calf muscles, which reduces tension contributing to irritation. For individuals with a high arch, customized orthotic inserts or simple heel lifts can alter the foot’s mechanics and reduce pressure on the bony bump. Protective heel pads or doughnut-shaped cushions can also provide padding between the heel and the shoe.
Permanent Resolution and Surgical Options
The structural deformity generally does not resolve on its own. Haglund’s deformity is a permanent bony overgrowth that will not shrink or go away without direct intervention. While conservative measures are effective at relieving the associated pain and swelling, they do not change the shape or size of the calcaneus.
For most patients, conservative management successfully controls the symptoms, allowing them to live comfortably with the structural deformity. If severe pain and inflammation persist despite six to twelve months of consistent non-surgical treatment, surgical intervention may be considered. The goal of surgery is to permanently remove the bony prominence to stop the chronic irritation.
The most common surgical procedure involves removing the excess bone, often called a calcaneal osteotomy or exostectomy. This procedure may be performed using open surgery or minimally invasive, endoscopic techniques. Recovery can be lengthy if the Achilles tendon must be detached and reattached, often requiring a walking boot and restricted weight-bearing for several weeks.