Haglund’s Deformity
Haglund’s deformity is an enlargement of bone in the back of the heel that is aggravated by shoe irritation. It occurs most commonly in women who wear pump shoes and the deformity is commonly known as the”pump bump”.
Symptoms of the deformity include:
- a reddened spot on the back of the heel
- a noticeable bump on the back of the heel
- swelling (bursitis)
- Achilles tendinitis
Haglund’s deformity affects people with high arched feet or people with tight calf muscles that put stress on the Achilles tendon. People with high arched feet have a heel bone the tilt backwards(like the heel position while coming down a ladder). This places strain on the Achilles tendon. The irritation and strain of the upturned heel bone against the tendon begins to form the bony prominence we call Haglund’s deformity. There are also two bursa sacs (fluid filled sacs) in this area that can become inflammed and painful. This condition is called bursitis and is the most common source of pain associated with Haglund’s deformity.
People with high arched feet tend to walk on the outside of their foot. Their heel bone is inverted (the ankle sprain position) and in Haglund’s deformity the bony excess tends to form on the outside corner of the heel. If the bony prominence is located more in the midline of the heel, this could be a heel spur which is directly resultant from Achilles tendinitis or rare metabolic disorders.
An evaluation by the podiatrist should include:
- a history of the complaint, aggravating factors
- a biomechanical examination of the lower extremities
- xrays of the foot and /or ankle
- inspection of footgear
An evaluation may include:
- Diagnostic Ultrasound
- Vascular or neurologic tests
- Blood tests
- MRI, CT scan
Conservative care is used to treat the associated tendinitis and bursitis. Only surgery can reduce the Haglund’s deformity.
Conservative care includes:
- Anti-inflammatory medicines (NSAIDs)
- Rest and Heat
- Calf stretching exercises
- Heel lifts in the shoe
- Direct padding of the area
- Wearing backless shoes or soft backed shoes
- Physical Therapy with Phonophoresis
- Orthotics
- Walking Boot
Surgery is indicated if conservative measures fail to alleviate pain or the patient has an inability to wear shoes comfortably. Surgery is done on an outpatient basis. The surgeon’s instructions must be closely followed. A period of non-weightbearing with crutches or knee roller may follow removal of the Haglund’s Deformity.
Dr. Marc Fink
