Haglund’s deformity occurs when irritation to the heel bone causes it to grow a protrusion. This condition is often precipitated by wearing shoes with rigid backs that rub against the heel.
Haglund’s deformity can cause the development of bursitis, which is a painful condition in the heel.
Treatment often involves wearing comfortable shoes, applying ice, and stretching or exercising the tendon in the heel. Surgery is reserved for more difficult cases that are resistant to less invasive forms of treatment.
What Is Haglund’s Deformity?
Haglund’s deformity is a bony protrusion on the back of the heel bone (the calcaneus). This protrusion is not something a person is born with; it develops later in life.
Having this extra piece of bone in the back of the foot can lead to bursitis in the heel. Bursitis is a painful condition that is caused by inflammation of the bursa, which is a sac located between the tendon and the bone in the heel.
What Causes Haglund’s Deformity?
Haglund’s deformity often occurs in young women who wear high-heeled shoes. For this reason, it is also sometimes called the “pump bump.” The hard heel of a pump can rub against the back of the heel bone with every step.
The constant pressure can lead to painful irritation in the bursa and in other tissue in the back of the foot, such as the Achilles tendon.
Haglund’s deformity is not an inherited condition, but other heritable conditions in the foot can contribute to its development. Some conditions that may also be present include:
High arches: The Achilles tendon tendon is the largest tendon in the body, and it connects the muscles in the calf to the heel bone. A high arch is caused when the heel bone is out of position and tilts back into the Achilles tendon.
The result of a high arch is that the heel bone actually rubs against the tendon, causing irritation. Over time, the heel bone begins to deform. The deformity rubs against another structure in the foot, the bursa. The bursa is a fluid-filled sac whose purpose is to eliminate friction between the tendon and the heel bone. When the bursa is irritated, it becomes inflamed and can cause significant pain.
Tight Achilles tendon: The bursa is between the Achilles tendon and the heel bone. If the Achilles tendon is too inflexible, it puts pressure on the bursa. The constant pressure can also result in inflammation and pain from the bursa.
Over pronation: People who over-pronate walk on the outsides of their feet. Walking on the outside of the foot causes an inside rotation of the heel. In this instance, a bursa may form under the tendon to reduce the friction caused by the abnormal foot rotation. The bursa is under so much pressure that it becomes inflamed and causes pain.
Signs and Symptoms of Haglund’s Deformity
The hallmark of Haglund’s deformity is the bony bump in the back of the heel. The other symptoms of Haglund’s deformity are:
- Heel pain
- Swelling in the heel
- Redness in the heel
- Bony heel protrusion
How Is Haglund’s Deformity Diagnosed?
Haglund’s deformity is typically diagnosed after reviewing the patient’s medical history and doing one or more imaging studies on the foot. x-rays, ultrasound, or magnetic resonance imaging (MRI) might be used by a podiatrist to visualize the new bone growth and also to rule out any other possible causes of pain in the heel.
Treating Haglund’s Deformity
The pain from Haglund’s deformity can often be treated at home. Treatment may reduce the pain and inflammation, but it will not have an effect on the new bone that has formed in the back of the heel. In extreme cases, heel surgery may be considered.
Changing footwear: High-heeled shoes or shoes with inflexible heels can contribute to the inflammation of the bursa. Wearing shoes that are more flexible can be helpful in stopping irritation in the heel.
Shoes that don’t have backs, such as sandals or clogs, may also be helpful. It is still important to wear supportive footwear, however, especially if there are other foot conditions present, such as a high arch.
Ice: Applying ice to the heel may help with pain and inflammation. Ice can be applied for about 20 minutes at a time, several times a day.
Rest: Resting the heel and foot by immobilizing the foot with a walking boot, or even with a temporary cast, can help stop the cycle of inflammation.
Going barefoot: If shoes are causing the bursa to become inflamed and preventing healing, going without them may help. This is often not practical, but it can be done at certain times, especially when you are at home.
Anti-inflammatory medications: Non-steroidal anti-inflammatory medications may help relieve pain and calm the inflammation. Both oral and topical medications can be effective, but patients should check with their physicians to find out which types of drugs might be helpful, and what dosages would be most effective.
Exercise: If the Achilles tendon is tight, stretching may help it to become more flexible and exert less pressure on the bursa. A physical therapist can recommend regular exercises that are likely to help with flexibility and prevent recurrence.
Orthotics or padding: For patients who over-pronate or have high arches, an orthotic worn in the shoe may help put the foot into better alignment. An orthotic can be bought over the counter, but one can also be custom-made by a podiatrist. Padding placed inside the heels of shoes may also help reduce friction against the heel bone.
Surgery: In some cases, comfort measures do not provide enough relief from the pain and discomfort of Haglund’s deformity. Several different types of surgery may be considered as a treatment, and more than one procedure may be needed to solve the problem.
If the tendon has become inflamed, debridement surgery to remove those strands of tendon that have been affected might be helpful. Removal of the bursa(e) and the actual protrusion of bone on the heel (a procedure known as ostectomy) may also be done.
If the Achilles tendon is too damaged, surgery may be performed to detach it from the heel bone, remove the inflamed section, and reattach the tendon to the bone. In cases in which a significant portion of the tendon must be removed, a piece of tendon taken from the toes may be used to augment or lengthen the Achilles tendon.
Recovery from surgery can take anywhere from six months to two years, but in most cases patients see an improvement in their pain.
How Can I Prevent Haglund’s Deformity?
Preventing Haglund’s deformity or preventing a recurrence after treatment means taking measures to treat any other existing foot conditions and to avoid aggravating the Achilles tendon and the bursa(e). Low-heeled footwear with a flexible back that supports the arch of the foot can help prevent the bursitis from recurring.
Exercises and stretches that keep the Achilles tendon flexible may also be useful in preventing inflammation and heel pain. Repetitive motion in the foot and ankle, especially running on a hard surface, should be avoided.