Haglund’s deformity is a bony enlargement that forms on the back of the heel bone, known as the calcaneus. This abnormal bone growth often causes irritation where the Achilles tendon attaches and can lead to painful inflammation of the fluid-filled sac, or bursa, that sits between the tendon and the bone. The condition is commonly referred to as “pump bump” because footwear with a rigid back, such as certain dress shoes or pumps, frequently rubs and aggravates the area, leading to pain and swelling.
Immediate At-Home Relief Measures
Managing Haglund’s deformity starts with immediate modifications to footwear by avoiding shoes with a stiff or rigid heel counter. Switching to open-backed shoes, like clogs or sandals, or using shoes with a soft, flexible back reduces the friction and pressure on the bony prominence. This primary strategy focuses on reducing irritation and inflammation using conservative, readily available methods.
Applying the R.I.C.E. principle helps manage acute symptoms. Icing the affected area for 15 to 20 minutes several times a day helps constrict blood vessels and reduce localized swelling and inflammation of the retrocalcaneal bursa. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be taken to help manage pain.
Stretching the Achilles tendon is useful, as a tight tendon can increase pressure on the bursa and the bony bump. Exercises like standing calf stretches against a wall or using a towel to pull the foot toward the body while sitting improve flexibility and reduce tension. These steps should be tried for a period of weeks before seeking professional care if the pain persists.
Professional Non-Surgical Treatment Options
If at-home measures fail to provide lasting relief, a healthcare provider can offer several professional non-surgical treatments. These interventions aim to address the underlying biomechanical factors and chronic inflammation contributing to the pain. Prescription-strength NSAIDs may be utilized for a potent reduction of pain and inflammation.
Physical therapy protocols are designed to improve the flexibility and strength of the lower leg muscles. A therapist may employ modalities like deep tissue massage, ultrasound therapy, or specific strengthening exercises, such as controlled heel drops, to reduce strain on the Achilles tendon and surrounding tissues.
Custom-made orthotics or specialized shoe inserts correct foot mechanics and redistribute pressure away from the back of the heel. A heel lift or heel pad can slightly elevate the heel, which alters the angle of the calcaneus and reduces friction with the shoe and the tendon. In cases of severe bursitis, injection therapy involving a corticosteroid may be considered to directly calm the inflammation. Caution is required, as the injection must be precisely placed into the bursa and away from the Achilles tendon to avoid weakening the tendon fibers and increasing the risk of rupture.
Surgical Solutions and Recovery Expectations
Surgery is recommended only after a patient has failed at least six months of non-surgical treatment. The primary goal of any surgical procedure is to permanently remove the bony prominence and the source of mechanical irritation. One common approach is a simple ostectomy, where the surgeon removes the excess bone from the back of the heel and often performs a retrocalcaneal bursectomy to remove the inflamed tissue.
A more involved procedure is a calcaneal osteotomy, typically considered when the heel bone’s angle is structurally problematic. This involves removing a small wedge of bone from the heel, rotating the heel bone to reduce the impingement on the Achilles tendon without having to detach the tendon itself.
Post-operative recovery for Haglund’s deformity surgery is lengthy and requires significant patient commitment. The foot is typically immobilized in a splint or non-weight-bearing cast for approximately two weeks. Once the sutures are removed, the patient transitions to a walking boot, often with a heel wedge protocol, and begins protected, partial weight-bearing. Full recovery can take several months, with some patients noting intermittent discomfort for up to a year. Physical therapy starts soon after the initial immobilization period to restore range of motion and strength, but calf stretching is avoided early on to protect the surgical site.