Haglund’s deformity is a common foot condition characterized by a bony enlargement on the back of the heel. This condition can lead to pain and inflammation in the surrounding soft tissues, often impacting daily activities and shoe wear. This article provides an overview of Haglund’s deformity, its causes, and available treatments.
Understanding Haglund’s Deformity
Haglund’s deformity involves an abnormal bony prominence, or exostosis, located on the back of the heel bone (calcaneus). This bony growth occurs where the Achilles tendon inserts into the heel bone. The presence of this enlargement can lead to irritation of nearby soft tissues, including the retrocalcaneal bursa, a fluid-filled sac between the Achilles tendon and heel bone, and the Achilles tendon itself.
When the bony prominence rubs against the bursa, it can cause inflammation, known as bursitis. Friction against the Achilles tendon can also result in tendinopathy, which is a breakdown or degeneration of the tendon. The condition is often colloquially referred to as “pump bump” because the rigid backs of certain shoes like high heels or dress shoes can exert pressure on the bony enlargement, aggravating symptoms.
Identifying Causes and Symptoms
While the exact cause of Haglund’s deformity is not fully understood, several factors contribute to its development. Inherited foot structures, such as a high arch, a tight Achilles tendon, or a tendency for the foot to roll outward during walking (supination), can predispose individuals. These biomechanical factors can increase pressure and friction on the back of the heel.
Footwear choices also play a significant role; shoes with rigid backs, like pumps, ice skates, or certain boots, can rub against the heel and exacerbate irritation. Repetitive stress, particularly from activities like running, can also contribute to the condition.
Symptoms of Haglund’s deformity include pain at the back of the heel, which often worsens with activity or when wearing restrictive shoes. Individuals may also observe a noticeable bony bump on the back of the heel. Swelling and redness in the affected area are common.
Diagnosis and Confirmation
Medical professionals diagnose Haglund’s deformity through physical examination and imaging studies. During a physical examination, a doctor will inspect the heel for the characteristic bony prominence, assess for tenderness, and evaluate the range of motion in the ankle. Swelling and skin discoloration around the bump are also indicators.
X-rays are used to visualize the bony spur on the calcaneus and to assess the overall structure of the foot. While X-rays show bone, magnetic resonance imaging (MRI) may be used for detailed assessment of soft tissue involvement, such as the extent of bursitis or Achilles tendinopathy. Imaging helps confirm the diagnosis and rule out other potential causes of heel pain.
Treatment Options
Managing Haglund’s deformity begins with non-surgical approaches, aiming to alleviate pain and inflammation. Rest, applying ice, and taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce discomfort and swelling. Physical therapy is recommended, focusing on stretching exercises to improve flexibility in the Achilles tendon and calf muscles, which reduces tension on the heel.
Modifying footwear is another non-surgical strategy. This involves avoiding shoes with rigid backs and opting for open-backed or soft-backed shoes to minimize pressure on the bony prominence. Heel pads, heel lifts, or custom orthotic inserts can provide cushioning, redistribute pressure, and support proper foot mechanics. In some cases, immobilization with a cast or walking boot may be necessary if the inflammation is severe.
If conservative treatments do not provide sufficient relief, surgical intervention may be considered. Procedures involve removing the bony prominence (Haglund’s osteotomy) and excising the inflamed bursa (bursectomy). If the Achilles tendon has sustained damage, such as degeneration, it may also be debrided or repaired during the surgery. Surgery is reserved as a last resort when non-surgical methods have failed to manage symptoms.
Preventive Measures
Preventing Haglund’s deformity or reducing its recurrence involves attention to footwear and foot care. Choose well-fitting shoes with soft heel counters and adequate cushioning, while avoiding shoes with rigid or narrow backs that rub against the heel. Open-backed shoes can also alleviate pressure.
Regular stretching of the Achilles tendon and calf muscles maintains flexibility and reduces tension on the heel. Gradual increases in the intensity and duration of physical activities prevent overuse injuries. For individuals with predisposing foot mechanics, such as high arches, consulting a podiatrist for custom orthotics or shoe inserts can provide support and control foot motion.