Haglund’s deformity is a common, painful affliction of the foot affecting the back of the heel. Known informally as “pump bump” due to its association with certain types of stiff-backed footwear, this condition can cause significant discomfort and limit a person’s mobility. This bony enlargement is a frequent source of consultation for foot and ankle specialists.
Defining the Condition
Haglund’s deformity is an abnormality characterized by a bony enlargement, known as an exostosis, on the upper back portion of the heel bone (the calcaneus). This overgrowth creates a prominent ridge that rubs against surrounding soft tissues.
The condition frequently involves two related issues that intensify the discomfort. The bony bump often irritates the retrocalcaneal bursa, a small, fluid-filled sac situated between the Achilles tendon and the calcaneus. This irritation leads to inflammation and swelling of the bursa, a painful condition known as retrocalcaneal bursitis.
The enlarged bone and the inflamed bursa can also press against the Achilles tendon insertion point. The constant friction and pressure contribute to irritation and pain in the tendon itself.
Recognizing the Signs
The most frequent complaint is pain and tenderness at the back of the heel. This discomfort often becomes more pronounced when walking, running, or standing for long periods. The pain is typically localized just above the attachment of the Achilles tendon, where the bony prominence is situated.
A visible sign is a hard, noticeable bump (the bony exostosis) on the posterior side of the heel. Constant rubbing from footwear can lead to localized swelling and redness in the overlying soft tissues. Pain is significantly aggravated when wearing shoes with a rigid heel counter, such as dress shoes, skates, or certain athletic footwear.
The skin covering the affected area may become thickened or discolored due to chronic irritation and pressure. The combination of the firm bump and soft tissue inflammation makes the back of the heel extremely sensitive to touch.
Contributing Factors and Prevention
The development of Haglund’s deformity is attributed to a combination of internal (intrinsic) structural factors and external influences. Intrinsic factors relate to foot structure and gait mechanics. Individuals with a high arch or a foot that tends to walk on the outside (supination) may put more pressure on the back of the heel, predisposing them to the condition.
A rigid heel structure, where the foot does not easily flatten upon impact, also contributes to rubbing against the calcaneus. Extrinsic factors primarily involve the choice of footwear. Wearing shoes with a rigid, unyielding back causes continuous pressure and friction where the bony prominence forms.
Prevention focuses on mitigating these external factors. Choosing shoes with soft, flexible heel counters or those that are open-backed significantly reduces friction on the sensitive area. Specialized heel pads or custom orthotics manage intrinsic factors by altering foot biomechanics and reducing pressure on the heel bone.
Treatment Approaches
Initial management of Haglund’s deformity is conservative, aiming to reduce inflammation and pain. Resting the foot and applying ice helps decrease swelling in the inflamed bursa. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are often recommended to manage both pain and inflammation.
Physical therapy is beneficial, focusing on Achilles tendon stretching exercises to relieve tension and improve flexibility. Conservative care also includes shoe modifications, such as wearing open-back shoes or using a heel lift to reduce pressure from the shoe’s collar. Custom orthotic devices correct underlying foot mechanics like excessive pronation or a high arch.
When conservative treatment fails after several months, surgical intervention may be considered. The primary procedure involves removing the bony exostosis on the calcaneus, called calcaneal osteotomy or resection of the posterior calcaneal prominence. This eliminates mechanical pressure and friction on the bursa and the Achilles tendon. Recovery involves immobilization followed by physical therapy to restore strength and range of motion.