Haglund’s deformity is a common condition presenting as a visible bony protrusion on the back of the heel. This enlargement occurs on the posterior aspect of the calcaneus (heel bone), near the Achilles tendon attachment. The resulting bump rubs against the rigid backs of shoes, creating friction and pressure that causes pain. The pain stems from the irritation and inflammation of soft tissues, particularly the retrocalcaneal bursa, a fluid-filled sac that acts as a cushion. Treatment involves targeted strategies to alleviate symptoms, ranging from simple modifications to surgical correction.
Understanding the Deformity and Its Causes
Haglund’s deformity is a bony overgrowth on the upper back portion of the heel bone, often referred to as the posterosuperior calcaneal prominence. It is nicknamed “pump bump” due to its association with rigid, closed-back footwear, such as high-heeled pumps, which press directly against the enlargement. This chronic mechanical irritation from rigid footwear is the primary external factor causing painful symptoms.
The deformity is often influenced by an individual’s foot mechanics and inherited structure. People with a high foot arch (pes cavus foot) may be predisposed because the heel bone is often tilted backward, increasing contact with the shoe counter. A naturally tight Achilles tendon can also increase pressure on the heel bone, exacerbating friction from footwear. Diagnosis involves a physical examination of the bump, confirmed by a lateral X-ray to visualize the bony spur and determine its size.
Non-Surgical Strategies for Symptom Relief
Immediate Pain Management
Initial management focuses on reducing inflammation and pain caused by soft tissue irritation. Applying ice to the affected area for 15 to 20 minutes several times daily helps minimize swelling and numb the pain. Limiting aggravating activities, such as long-distance running or walking on hard surfaces, allows inflamed tissues to recover. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, can be recommended by a physician to reduce inflammation and provide temporary pain relief. These medications manage acute symptoms but do not address the underlying bony enlargement or mechanical cause of the irritation.
Footwear Modification
Changing footwear is crucial for managing Haglund’s deformity. Shoes with rigid heel counters or stiff backs must be avoided, as they are the direct source of friction against the bony bump. Switching to open-backed shoes, such as clogs or sandals, eliminates pressure on the painful area.
If closed-back shoes are necessary, select footwear with a soft, flexible, or padded heel collar to reduce irritation. Heel lifts or pads placed inside the shoe can slightly raise the heel, changing the angle of the heel bone and reducing pressure. Some individuals may also benefit from having a podiatrist cutting out a section of the shoe’s heel counter to create a custom space for the bump.
Physical Therapy and Stretching
Targeted physical therapy is beneficial for patients with a tight Achilles tendon, a common contributing factor. Specific stretching exercises for the calf muscles (gastrocnemius and soleus) and the Achilles tendon lengthen these tissues, reducing tension and pressure on the heel bone. A common stretch involves leaning toward a wall with one foot back, keeping the heel on the floor until a pull is felt in the calf. Eccentric heel drops, where heels are slowly lowered from a raised surface, strengthen the calf muscles while lengthening the Achilles tendon. Consistent routines improve flexibility, reduce strain, and minimize mechanical forces exacerbating the deformity.
Custom Orthotics
Custom-made or over-the-counter orthotic devices offer relief for individuals whose foot structure contributes to the condition. These inserts control foot mechanics, especially for those with high arches. By providing proper arch support, orthotics position the foot correctly, decreasing the backward tilt of the heel bone and reducing Achilles tendon impingement. This stabilization reduces the abnormal stresses that cause chronic irritation.
Surgical Options for Permanent Correction
Surgical intervention may be considered if conservative treatment fails to provide adequate relief after six to twelve months. Surgery is the only method that physically removes the bony prominence. The primary goal is to remove excess bone and any inflamed bursa without damaging the Achilles tendon.
Excision and Debridement
A common procedure is simple excision, which involves surgically removing the bony prominence from the calcaneus and often excising the retrocalcaneal bursa (bursectomy). If the Achilles tendon is severely damaged, the surgeon may perform a debridement (cleaning) of the tendon, requiring temporary detachment and reattachment to the heel bone. Open surgical techniques use a larger incision, while endoscopic approaches use smaller incisions and specialized instruments, often leading to a shorter recovery time.
Calcaneal Osteotomy
A more complex procedure, such as a calcaneal osteotomy, may be necessary if the overall shape or angle of the heel bone significantly contributes to the problem. This involves cutting and reshaping the heel bone itself, such as using a wedge-shaped bone removal (Zadek procedure) to change the alignment and reduce pressure on the tendon. Following surgery, patients typically require immobilization in a cast or boot for about six weeks, followed by a gradual return to full weight-bearing and physical therapy.