Haglunds Deformity

What Is Haglund’s Deformity?

Haglund’s deformity is a bony

enlargement on the back of the

heel that most often leads to painful

bursitis, which is an inflammation of

the bursa (a fluid-filled sac between

the tendon and bone). In Haglund’s

deformity, the soft tissue near the

Achilles tendon becomes irritated

when the bony enlargement rubs

against shoes.

Haglund’s deformity is often

called “pump bump” because the

rigid backs of pump-style shoes can

create pressure that aggravates the

enlargement when walking. In fact,

the deformity is most common in

young women who wear pumps.

Symptoms

Haglund’s deformity can occur in

one or both feet. The signs and

symptoms include:

• A noticeable bump on the back of

the heel

• Pain in the area where the Achilles

tendon attaches to the heel

• Swelling in the back of the heel

• Redness near the inflamed tissue

What Causes

Haglund’s Deformity?

To some extent, heredity plays a

role in Haglund’s deformity. People

can inherit a type of foot structure

that makes them prone to developing

this condition.

For example, high arches can

contribute to Haglund’s deformity.

The Achilles tendon attaches to the

back of the heel bone, and in a person

with high arches, the heel bone is tilted

backward into the Achilles tendon.

This causes the uppermost portion

of the back of the heel bone to rub

against the tendon. Eventually, due to

this constant irritation, a bony protrusion

develops and the bursa becomes

inflamed. It is the inflamed bursa that

produces the redness and swelling

associated with Haglund’s deformity.

A tight Achilles tendon can also

play a role in Haglund’s deformity,

causing pain by compressing the

tender and inflamed bursa. In

contrast, a tendon that is more

flexible results in less pressure

against the painful bursa.

Another possible contributor to

Haglund’s deformity is a tendency to

walk on the outside of the heel. This

tendency, which produces wear on

the outer edge of the sole of the shoe,

causes the heel to rotate inward,

resulting in a grinding of the heel

bone against the tendon. The tendon

protects itself by forming a bursa,

which eventually becomes inflamed

and tender.

Diagnosis

After evaluating the patient’s symptoms,

the foot and ankle surgeon will

examine the foot. In addition, x-rays

will be ordered to help the surgeon

evaluate the structure of the heel bone.

Treatment:

Non-surgical Approaches

Non-surgical treatment of Haglund’s

deformity is aimed at reducing the

inflammation of the bursa. While

these approaches can resolve the

bursitis, they will not shrink the

bony protrusion. Non-surgical

treatment can include one or more

of the following:

• Medication. Anti-inflammatory

medications may help reduce the

pain and inflammation. Some

patients also find that a topical

pain reliever, which is applied

directly to the inflamed area,

is beneficial.

• Ice. To reduce swelling, apply a

bag of ice over a thin towel to the

affected area for 20 minutes of

each waking hour. Do not put ice

directly against the skin.

• Exercises. Stretching exercises

help relieve tension from the

Achilles tendon. These exercises

are especially important for the

patient who has a tight heel cord.

• Heel lifts. Patients with high arches

may find that heel lifts placed inside

the shoe decrease the pressure on

the heel.

• Heel pads. Placing pads inside the

shoe cushions the heel and may

help reduce irritation when walking.

• Shoe modification.Wearing shoes

that are backless or have soft backs

will avoid or minimize irritation.

• Physical therapy. Inflammation is

sometimes reduced with certain

forms of physical therapy, such as

ultrasound therapy.

• Orthotic devices. These custom

arch supports are helpful because

they control the motion in the foot,

which can aggravate symptoms.

• Immobilization. In some cases,

casting may be necessary to

reduce symptoms.

When Is Surgery Needed?

If non-surgical treatment fails to

provide adequate pain relief, surgery

may be needed. The foot and ankle

surgeon will determine the procedure

that is best suited to your case. It is

important to follow the surgeon’s

instructions for post-surgical care.

Prevention

A recurrence of Haglund’s deformity

may be prevented by:

• Wearing appropriate shoes; avoid

pumps and high-heeled shoes

• Using arch supports or orthotic

devices

• Performing stretching exercises

to prevent the Achilles tendon

from tightening

• Avoiding running on hard surfaces

and running uphill ▲