Haglund’s Deformity (HD) is a common, painful orthopedic condition affecting the posterior heel. It involves a structural abnormality of the calcaneus, or heel bone, leading to chronic irritation and discomfort. This article will explain the nature of Haglund’s Deformity, detailing its appearance, causes, diagnosis, and treatment.
Defining Haglund’s Deformity and Its Appearance
Haglund’s Deformity is a bony enlargement, or exostosis, located on the superior posterior aspect of the calcaneus. This protrusion is informally known as “pump bump” due to its association with wearing rigid-backed shoes. The enlargement changes the normal heel contour, creating a noticeable bump just above the Achilles tendon attachment.
This bony prominence compresses and irritates adjacent soft tissues. The exostosis impinges on the retrocalcaneal bursa, a fluid-filled sac between the Achilles tendon and the heel bone. Constant friction causes the bursa to become inflamed, resulting in retrocalcaneal bursitis. The Achilles tendon itself can also be affected, as it passes directly over the bony projection. Chronic rubbing leads to tendon irritation, thickening, and pain, contributing to the characteristic discomfort.
Primary Causes and Risk Factors
The development of Haglund’s Deformity is attributed to a combination of inherited foot structure and external mechanical stressors. Biomechanical factors play a significant role, particularly in individuals with foot types that increase pressure on the heel bone. For instance, people with a high arch (pes cavus) often walk with the heel tilted slightly inward, forcing the upper edge of the heel bone against the Achilles tendon insertion.
Similarly, a rigid foot structure, meaning the foot does not easily flatten or absorb shock during walking, increases susceptibility. This lack of flexibility increases tension and friction exerted on the posterior heel. These inherited structural issues predispose the heel to bony enlargement. External factors then act as triggers, making the condition symptomatic. Footwear is a major contributor, especially shoes with a firm, rigid back or a stiff heel counter. These restrictive shoes repeatedly compress the retrocalcaneal bursa and the bony prominence. The constant mechanical friction stimulates the bone to grow outward, forming the characteristic exostosis.
Recognizing the Symptoms and Diagnosis
The primary symptom is localized pain and tenderness at the back of the heel where the bony protrusion is located. This discomfort is often accompanied by noticeable soft tissue swelling, a direct result of the underlying bursitis. The skin covering the heel bump may also become reddened, warm to the touch, and irritated due to friction against footwear. Pain commonly increases with physical activities like running or prolonged walking, and wearing rigid-backed shoes predictably exacerbates the symptoms.
A physician confirms the condition through a physical examination, palpating the area to locate the bony prominence and assess tenderness and swelling. The doctor differentiates the pain from other conditions, such as isolated Achilles tendonitis, by evaluating the specific location of the discomfort. Imaging is necessary to confirm the diagnosis and plan treatment. X-rays are the standard imaging tool, clearly visualizing the bony structure of the calcaneus. The lateral view allows the physician to measure the size and shape of the exostosis and rule out other potential causes of posterior heel pain, such as a stress fracture or calcification within the Achilles tendon.
Treatment Approaches
Conservative Treatment
Treatment begins with conservative methods aimed at reducing inflammation and relieving pressure on the heel. The simplest intervention involves modifying footwear to eliminate friction, often by wearing open-back shoes or those with soft, pliable heel counters. Anti-inflammatory medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs), manages the pain and reduces the swelling associated with the bursitis.
Mechanical Relief and Physical Therapy
Other conservative measures focus on mechanical relief and reducing strain on the Achilles tendon. Heel lifts placed inside the shoe can slightly raise the heel, decreasing pressure on the irritated retrocalcaneal bursa. Physical therapy may be prescribed, including stretching exercises for the Achilles tendon to relieve tension and improve flexibility. Applying ice to the affected area several times a day further helps decrease localized inflammation.
Surgical Intervention
If symptoms do not improve after several months of consistent conservative management, surgical intervention may be considered. The goal of the operation, often a calcaneal osteotomy or excision, is to permanently address the mechanical cause of the problem. This procedure involves surgically removing the bony prominence from the posterior superior aspect of the calcaneus. The surgeon may also remove the inflamed retrocalcaneal bursa (bursectomy) during the same procedure to alleviate the chronic irritation. Surgical correction eliminates the mechanical source of the friction, allowing the soft tissues to heal and providing long-term relief.