Haglund’s Deformity is a common source of pain and discomfort affecting the back of the heel, characterized by a visible bump. This condition is often misidentified, sometimes confused with other types of heel pain or dismissed as a callus. The bony enlargement is a physical manifestation on the heel bone (calcaneus), which creates friction and irritation with the surrounding soft tissues. Understanding the specific nature of this condition is the first step toward finding relief and effective management strategies.
Defining the Condition and Addressing the Bone Spur Question
Haglund’s Deformity is a bony enlargement located on the upper-back portion of the heel bone (calcaneus), near the Achilles tendon connection. While the public uses the term “bone spur,” medical professionals refer to this growth as a posterior superior calcaneal prominence or calcaneal exostosis. This distinction is important because traditional heel spurs develop on the bottom of the heel bone, whereas Haglund’s Deformity is located on the back.
The condition is often called Haglund’s Syndrome, which includes the bony protrusion and painful irritation of adjacent soft tissues. This involves irritation of the Achilles tendon and inflammation of the retrocalcaneal bursa. The bursa is a small, fluid-filled sac situated between the tendon and the bone, acting as a cushion. The constant rubbing of the bony bump against the bursa and tendon generates the characteristic pain and swelling.
Underlying Causes and Contributing Anatomical Factors
The development of this bony prominence is rooted in a combination of inherited foot structure and external mechanical forces. Individuals with a high arch, known as pes cavus, are more susceptible because this structure causes the heel bone to tilt backward and upward. This tilting increases the pressure exerted on the Achilles tendon insertion point.
A tight Achilles tendon is another anatomical factor, as it pulls on the heel bone and contributes to the bony enlargement over time. Tightness in the calf muscles places excessive tension on the insertion site, prompting the bone to grow this extra prominence.
External pressure from footwear acts as a catalyst for pain and inflammation in those anatomically predisposed. Rigid heel counters, commonly found in men’s dress shoes, ice skates, or women’s pump-style shoes, press directly against the bony prominence and the retrocalcaneal bursa. This repetitive friction is strongly associated with the condition, which is often nicknamed “pump bump.”
Recognizing the Symptoms and Confirmation
The primary sign of Haglund’s Deformity is a visible, hard bump at the back of the heel, near the Achilles tendon attachment. Patients experience pain and tenderness, which is exacerbated by wearing shoes with firm backs. This pain results from the inflamed retrocalcaneal bursa, a condition called retrocalcaneal bursitis, which causes localized swelling and redness.
The pain often feels like a deep ache and may worsen during or after activity, such as walking or running. Diagnosis begins with a physical examination, where the doctor notes the presence of the bony bump and tests for tenderness. Pressing on the area directly in front of the Achilles tendon insertion often elicits pain due to the inflamed bursa.
Confirmation is typically achieved through X-rays of the heel. These images allow the physician to clearly visualize the size and shape of the bony prominence on the calcaneus. The X-ray helps to differentiate Haglund’s Deformity from other causes of heel pain, such as insertional Achilles tendinopathy or other types of heel spurs.
Treatment Pathways
Management of Haglund’s Deformity begins with non-surgical, conservative treatments aimed at reducing inflammation and relieving pressure on the heel. A fundamental step involves modifying footwear to eliminate the friction caused by rigid heel counters. Switching to open-backed shoes, such as clogs or sandals, or wearing shoes with soft, flexible materials in the heel area can provide immediate relief.
The use of anti-inflammatory medication, specifically nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, helps manage the pain and swelling associated with bursitis. Applying ice to the affected area for 15 to 20 minutes several times a day is also an effective component of the RICE protocol to reduce localized inflammation.
Mechanical adjustments to the foot’s position are employed to shift pressure away from the irritated area. Heel lifts placed inside the shoe can elevate the heel slightly, which changes the angle of the Achilles tendon and reduces its proximity to the bony prominence. Custom orthotic devices are often prescribed for individuals with high arches to control the foot’s motion and provide better biomechanical support.
Physical therapy plays a significant role, focusing on stretching exercises to lengthen and increase the flexibility of a tight Achilles tendon and calf muscles. Specific stretches help to reduce the tension that pulls on the calcaneus, which can mitigate the irritation of the bony prominence. Modalities like ultrasound therapy may also be used by a physical therapist to further reduce inflammation in the soft tissues.
If conservative measures fail to provide satisfactory pain relief after six to twelve months, a surgical procedure may be considered. The surgical option is calcaneoplasty, which involves removing the bony prominence from the back of the heel bone. This procedure effectively eliminates the source of the mechanical irritation, allowing the Achilles tendon and retrocalcaneal bursa to move freely without impingement.