Haglund’s deformity is a condition affecting the heel, characterized by an abnormal bony enlargement on the back of the calcaneus near where the Achilles tendon attaches. This prominence is often referred to as a “pump bump” because it is frequently aggravated by the rigid backs of certain shoe styles, such as pump heels. The bony growth causes irritation and friction on the surrounding soft tissues, most commonly leading to inflammation of the retrocalcaneal bursa—a fluid-filled sac between the tendon and the bone. Managing Haglund’s deformity involves a sequential approach to treatment, beginning with simple home care and escalating to professional procedures only if initial measures fail.
Initial Steps: Recognizing the Condition and Starting Conservative Care
The first step in addressing persistent heel pain is typically a medical evaluation, which often confirms Haglund’s deformity through a physical examination and imaging studies. An X-ray is the standard tool used to visualize and confirm the bony prominence. Imaging also helps a healthcare provider assess the extent of the enlargement and check for other related issues, such as calcification or spur formation at the Achilles tendon insertion.
Once a diagnosis is established, the initial treatment focuses on alleviating pain and inflammation using non-invasive, conservative methods. A fundamental principle involves applying the RICE method: resting the foot, applying ice to the affected area for 15 to 20 minutes several times a day, and using over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. These actions aim to calm the acute inflammation in the bursa and surrounding tissues.
Footwear modification is one of the most impactful steps a person can take to manage symptoms at home. Patients are strongly advised to avoid shoes with stiff, closed backs that rub against the bony bump. Switching to open-backed shoes, such as clogs or sandals, or wearing shoes with soft, flexible heel counters can significantly reduce irritation.
Another simple yet effective mechanical adjustment is the use of heel lifts or pads placed inside the shoe. By slightly raising the heel, these devices reduce the strain and pull on the Achilles tendon, which in turn decreases pressure on the inflamed area. These early conservative measures are often sufficient to manage the pain and swelling, preventing the condition from worsening and delaying the need for more intensive intervention.
Advanced Non-Surgical Treatments
When a patient’s symptoms do not improve after several weeks of basic home care and footwear changes, professional non-surgical treatments are introduced. Physical therapy (PT) plays a significant role in this phase, focusing on correcting biomechanical factors that may contribute to the deformity’s irritation. A physical therapist will prescribe specific stretching exercises, particularly for the calf muscles and Achilles tendon, to improve flexibility and reduce tension on the heel.
Orthotic devices are frequently recommended to address underlying foot mechanics that exacerbate the problem, such as excessive pronation or high arches. Custom-made or over-the-counter arch supports and heel cups help control the foot’s motion and redistribute pressure away from the inflamed area. By stabilizing the foot, orthotics can prevent the heel from rolling outward, a movement pattern that often pushes the heel bone against the shoe counter.
For managing more severe inflammation, prescription-strength NSAIDs may be provided by a healthcare professional. In certain cases, a corticosteroid injection may be considered to deliver a potent anti-inflammatory medication directly into the inflamed retrocalcaneal bursa. Due to the risk of weakening the Achilles tendon and potential rupture, the injection must be placed carefully only into the bursa and not directly into the tendon itself.
Temporary immobilization may be necessary if the pain is severe and unresponsive to other treatments, allowing the tissues a chance to heal. This can involve using a walking boot or a similar brace for a short period to restrict movement and reduce stress on the heel. Extracorporeal shock wave therapy (ESWT) is another advanced option that uses high-energy sound waves to stimulate blood flow and healing in the area, although it does not reduce the size of the bony bump.
Surgical Procedures for Haglund’s Deformity
Surgery is generally reserved as a final measure, typically considered only after six to twelve months of comprehensive non-surgical treatment has failed to provide adequate relief. The primary goal is to remove the bony prominence causing the irritation, a procedure known as the excision of the posterior calcaneal prominence.
During the surgery, the surgeon removes the enlarged section of the heel bone and often excises the inflamed bursa, a process called a bursectomy. If the Achilles tendon has sustained damage or degeneration from chronic irritation, a portion of the tendon may need to be debrided and potentially reattached to the heel bone using suture anchors. This combined procedure is more complex and leads to a longer recovery period.
In cases where the bone’s angle is a major contributing factor, a calcaneal osteotomy may be performed, which involves removing a wedge of bone to change the shape and alignment of the heel. Recovery expectations vary depending on the extent of the procedure, particularly if the Achilles tendon needed to be detached and reattached. If the tendon is involved, patients are typically non-weight bearing for two to four weeks, followed by a transition to a walking boot with gradual weight-bearing. Physical therapy is a mandatory part of rehabilitation, and full recovery can take anywhere from three to twelve months.