Haglund's Deformity

What Is Haglund Deformity?
Haglund’s deformity, figure 1, is one of the more common causes of pain on the back of the heel that we treat in our Seattle foot and ankle clinic. It is a bony enlargement on the upper portion of the back of the heel bone (calcaneus). This “bump of bone” on the heel can trap the soft tissue of the Achilles tendon between the heel bone and the shoe resulting in irritation of the Achilles tendon, the skin and other soft tissue on the back of the heel. It can also cause a painful bursitis (inflammation of a fluid-filled sac between the tendon and bone). We are very successful at relieving pain from pump bumps without resorting to surgery.

Figure 1 - bump back of heel / Haglunds deformity

Causes of Haglund Deformity
Haglund deformity is sometimes called “pump bump” because the back of high heel pumps can press against the bony enlargement and cause pain and irritation. In fact, any shoes with a rigid back, including soccer shoes, men’s dress shoes, golf shoes, or women’s pumps, can cause this pain.
Your genetics also play a role in developing a pump bump. If you have inherited any of the following, then you more more likely to develop a Haglund deformity.

• A high-arched foot
• A tight Achilles tendon
• A tendency to stand and walk with pressure on the outside of the heel.

Symptoms
Haglund’s deformity can occur in one or both feet. The symptoms include:
• A bump on the back of the heel
• Tenderness in the back of the heel where the Achilles tendon attaches
• Swelling in the back of the heel
• Redness near the swelling

Diagnosis
Along with examining your feet, we will often take x-rays to evaluate the structure of the heel bone, size of the Haglund’s deformity and the involvement of the Achilles tendon.

Non-Surgical Treatment
Our goal is to avoid surgery if possible. Non-surgical treatment of Haglund’s deformity is directed at reducing the friction and pressure that is causing the irritation and at reducing any inflammation of the bursa. While these treatments may relieve pain, they will not make the bony enlargement any smaller. Only surgery can do that. Regardless, we are usually able to resolve pain without surgery. Non-surgical treatment may include one or more of the following:

• Custom Foot Orthotics: Custom orthotics in this situation are designed to limit abnormal motion that causes pain and irritation on the back of the heel.
• Medication: Oral anti-inflammatory drugs, such as naproxen, may be recommended to reduce the pain and inflammation.
• Ice: Icing for 10 minutes three times per day can help reduce inflammation.
• Exercises: Strengthening exercises for the Achilles tendon can be helpful in some cases. If your condition will respond to this, we will start you on these exercises.
• Stretching: Stretching exercises may help reduce Achilles tendon tension.
• Heel lifts: Patients with short heel cords may find that heel lifts placed inside the shoe decrease the tension on the Achilles tendon and pressure on the heel.
• Heel pads: Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.
• Shoe modification: We often prescribe stretching of shoes in the painful area.
• Shoe Changes: Backless or soft backed shoes help decrease pressure on the painful area.
• Physical therapy: Physical therapy modalities, such as ultrasound, can help to reduce inflammation.
• Immobilization: In some cases, temporary immobilization in a walking boot or cast can allow the tissue to heal.

When Is Surgery Needed?
If you have tried all non-surgical treatments and they have not provided adequate pain relief, then surgery for the pump bump may be needed. There are several operations that can help back of the heel pain and your foot and ankle surgeon will determine the procedure that will provide you the best result.

Prevention
You can help prevent a recurrence of Haglund’s deformity by:

• Avoiding shoes that press directly on the painful area on the back of the heel.
• Using orthotics or arch supports to limit abnormal motion
• Performing strengthening and stretching exercises to maintain strength and decrease tension in the Achilles tendon
• Avoiding excessive running on hard surfaces and running uphill.
• Cutting out the back inside of your shoe to allow room for the bump. Many patients may find old shoes are more comfortable than new shoes because they have worn a hole in the back of their shoe, Figure 2.
  Figure 2 - boney heel prominence has rubbed a hole in the back of the shoe. This actually reduces pressure on the bump and may reduce symptoms.

WEBSITE DISCLAIMER
For website errors ONLY email webmaster at WEBMASTER
All pages on this website © 2005-2010
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.