Haglund’s Deformity is a common foot condition affecting the back of the heel, leading to discomfort and impacting daily activities. Understanding this condition is important for individuals experiencing heel pain, as early recognition can facilitate effective management. The deformity involves specific anatomical structures, and its symptoms often become noticeable due to irritation from footwear or physical activity.
What is Haglund’s Deformity?
Haglund’s Deformity is characterized by a bony enlargement, or exostosis, on the posterior aspect of the calcaneus (heel bone), where the Achilles tendon attaches. This bony prominence can irritate the surrounding soft tissues, primarily the retrocalcaneal bursa and the Achilles tendon.
The retrocalcaneal bursa is a fluid-filled sac situated between the calcaneus and the Achilles tendon, functioning to reduce friction during movement. When the bony enlargement rubs against this bursa, it can lead to inflammation, a condition known as retrocalcaneal bursitis. Similarly, the Achilles tendon, which connects the calf muscles to the heel bone, can become inflamed, resulting in Achilles tendinitis. The condition is sometimes referred to as “pump bump” because certain types of shoes, particularly those with rigid backs like high heels or dress shoes, can aggravate the area.
Recognizing the Signs
Individuals with Haglund’s Deformity experience pain at the back of the heel, which often worsens with activity or pressure from shoes. Common signs include visible swelling, redness, and a noticeable bony bump on the posterior heel. These symptoms arise from the ongoing irritation and inflammation of the retrocalcaneal bursa and the Achilles tendon due to the bony prominence.
Several factors can contribute to the development of Haglund’s Deformity. Ill-fitting footwear, especially shoes with rigid backs that press against the heel, is a significant contributor. Certain foot mechanics also play a role, such as having high arches, a naturally tight Achilles tendon, or a tendency to walk on the outside of the heel. Genetic predisposition and overuse, particularly in athletes, are also considered risk factors.
Diagnosis and Management
Diagnosing Haglund’s Deformity begins with a physical examination by a healthcare professional. The doctor will palpate the affected area to assess tenderness, swelling, and the presence of the bony bump. Imaging studies are frequently used to confirm the diagnosis and rule out other conditions.
X-rays, particularly a lateral view, are the primary diagnostic tool as they clearly visualize the bony prominence on the calcaneus. An MRI or ultrasound may be utilized to further evaluate soft tissue involvement, such as the extent of bursitis or Achilles tendinitis. These imaging tests help guide the most appropriate treatment plan.
Management of Haglund’s Deformity begins with conservative (non-surgical) approaches aimed at reducing inflammation and pain. Rest, applying ice to the affected area, and taking over-the-counter anti-inflammatory medications like NSAIDs are common initial steps. Modifying footwear is a significant part of conservative care, including avoiding shoes with rigid heel backs and opting for open-back or soft-backed shoes.
Non-Surgical Treatments
Heel lifts or pads reduce pressure on the heel.
Custom orthotics provide support and improve foot mechanics.
Physical therapy, involving stretching exercises for the Achilles tendon and calf muscles, helps relieve tension and improve flexibility.
An immobilizing boot or cast may be used temporarily to allow the area to heal.
When conservative treatments do not provide sufficient relief, surgical options may be considered. The goal of surgery is to remove the bony prominence (a procedure known as exostectomy or calcaneal osteotomy) and address any inflamed bursa or damaged Achilles tendon. Surgical techniques can range from traditional open surgery, which may involve temporarily detaching and reattaching the Achilles tendon, to minimally invasive procedures designed for quicker recovery. Consulting with a healthcare professional is important to determine the most suitable diagnosis and treatment plan.