Haglund’s deformity, often called “pump bump” or “winter heel,” is a condition affecting the back of the heel. It involves a bony enlargement on the calcaneus, the heel bone. This enlargement can lead to discomfort and swelling due to pressure on the nearby Achilles tendon and inflammation of the retrocalcaneal bursa, a fluid-filled sac that reduces friction.
Prevalence of Haglund’s Deformity
Haglund’s deformity is a common cause of posterior heel pain, with its prevalence estimated to range from 2% to 6% in the general population. While it can affect anyone, certain demographic patterns and factors influence its occurrence. It is frequently observed in physically active individuals, particularly athletes, and those with specific foot biomechanics.
The condition appears to have a higher incidence among individuals with high-arched feet or tight Achilles tendons. Although it can affect both sexes, some studies have noted a higher percentage of females, with one study reporting 66.4% of patients being female, and an average age of 55.14 years. The condition can be unilateral or bilateral, affecting one or both heels.
Understanding the Condition
This deformity involves a bony protrusion on the upper-back part of the calcaneus. This prominence can irritate the Achilles tendon and the retrocalcaneal bursa. Constant rubbing and pressure on these structures can lead to inflammation and pain.
The deformity can arise from various factors. Genetics can play a role, predisposing individuals to the condition. Foot structure is another significant contributor; people with high foot arches are often more susceptible because their heel bone may tilt backward, increasing pressure on the Achilles tendon insertion.
Tightness in the Achilles tendon can also contribute, as it pulls the heel bone upwards and further presses the tendon against the bony enlargement. Walking patterns, specifically walking on the outside of the heel, can also contribute to the development or worsening of the condition by altering the mechanics and pressure distribution around the heel. Symptoms include a visible bump at the back of the heel, pain in the heel region, swelling, and sometimes a restricted range of motion in the ankle.
Diagnosis and Treatment Options
Diagnosing Haglund’s deformity begins with a physical examination. A healthcare professional will inspect the heel for the characteristic bony enlargement and assess tenderness, particularly around the retrocalcaneal bursa and Achilles tendon insertion. They may also evaluate the patient’s gait, foot structure, and Achilles tendon flexibility.
While a physical exam often provides strong indications, imaging studies offer further clarity. X-rays are commonly used to visualize the bony prominence on the calcaneus and confirm Haglund’s deformity. An MRI scan may be utilized if there is concern about Achilles tendon damage or to aid in planning surgical interventions by providing detailed soft tissue visualization.
Non-surgical treatments are the first line of approach to manage symptoms. These include nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. Heel lifts or pads placed inside shoes can help elevate the heel, reducing pressure on the Achilles tendon and retrocalcaneal bursa. Changing footwear to avoid shoes with rigid heel counters is also recommended to alleviate irritation. Physical therapy is another common non-surgical option, focusing on exercises to stretch the Achilles tendon and strengthen surrounding muscles, improving overall foot and ankle mechanics.
If conservative, non-surgical methods do not provide sufficient relief, surgical options may be considered. The goal of surgery is to remove the bony prominence and alleviate pressure on the Achilles tendon and bursa. Open surgery involves an incision at the back of the heel to access the bony spur. Minimally invasive procedures offer an alternative, involving smaller incisions that result in less pain, faster recovery, and a lower incidence of complications compared to open surgery.