Understanding the Bony Bump: A Guide to Haglund's Deformity

A bone spur on the back of the heel is known as Haglund’s deformity, which causes heel pain swelling and redness where a hard lump forms. It is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the heel when walking. Any shoes with a rigid back, such as ice skates, men’s dress shoes or women’s pumps, can cause “pump bump”. This bony enlargement develops where the Achilles tendon attaches to the heel bone (calcaneus) and is associated with Achilles Tendonitis and Bursitis.

It develops from irritation of the soft tissues surrounding the heel, leading to pain, inflammation, and difficulty in wearing shoes comfortably. Additionally, people with a high-arched foot structure or those with an abnormal gait pattern might be more prone to developing Haglund's Deformity.

How is Haglund's Deformity diagnosed?

A medical professional, usually a podiatrist or an orthopedic specialist, can diagnose Haglund's Deformity through a combination of physical examination, medical history assessment, and imaging studies. During the physical exam, the doctor will examine the heel for signs of swelling, redness, and tenderness. He or she will also assess the gait and foot structure. X-rays might be used to confirm the diagnosis and evaluate the extent of bony enlargement. In some cases, other imaging techniques like MRI or ultrasound might be recommended to assess soft tissue involvement.

What treatment options are available for Haglund's Deformity?

Treatment for Haglund's Deformity aims to relieve pain, reduce inflammation, and prevent further irritation. The approach taken depends on the severity of the condition and the patient's symptoms. Conservative Treatments would include:

  • Footwear Modification: Switching to shoes with softer backs and cushioning around the ?heel to help reduce friction and pressure.
  • Orthotics: Custom-made or over-the-counter shoe inserts can provide support and cushioning, relieving strain on the Achilles tendon.
  • Physical Therapy: Stretching exercises and physical therapy can help improve flexibility, strengthen the calf muscles, and alleviate discomfort.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) might be prescribed to reduce pain and inflammation.
  • Ice application and topical anti-inflammatory creams can help alleviate pain and reduce swelling.
  • Heel lifts or pads inserted into the shoes can reduce pressure on the heel and Achilles tendon.
  • Immobilization: In more severe cases, a cast or walking boot might be recommended to immobilize the foot and allow the inflamed tissues to heal.

Haglund's Deformity Infographic

How do you know if surgery is necessary?

If conservative treatments do not provide relief, surgical intervention might be considered. The procedure involves removing the bony prominence, reshaping the heel bone, and repairing the Achilles tendon if necessary. Surgical procedures aim to address the underlying structural issues causing the deformity. While surgery can provide long-lasting relief and improve foot function, it also involves a recovery period during which the foot must be protected and rehabilitated. Most patients can gradually return to their regular activities, including sports, with appropriate healing time and rehabilitation.

The outcome of Haglund's Deformity treatment varies depending on the severity of the condition and the chosen treatment approach. Many individuals experience relief from pain and discomfort through conservative treatments such as footwear modifications, orthotics, and physical therapy, but these measures only help manage symptoms and prevent the condition from worsening. Complete resolution of the bony prominence may not be achieved without surgical intervention.

Can Haglund's Deformity be prevented?

Preventing Haglund's Deformity involves taking steps to minimize the factors that contribute to its development. While some risk factors, like genetics and foot structure, might be beyond your control, there are still several measures you can take to reduce the likelihood of developing this condition:

  • Choose Proper Footwear: Choose shoes with softer backs and cushioning around the heel area. Avoid shoes with rigid or high backs that can create pressure and friction on the heel.
  • Avoid High Heels: Limit the use of high-heeled shoes, as they can put excessive pressure on the back of the heel and contribute to the formation of a bony prominence.
  • Wear Appropriate Shoe Sizes: Make sure your shoes fit properly. Shoes that are too tight can increase pressure and friction on the heel, potentially aggravating the condition.
  • Use Orthotics: Consider using custom-made or over-the-counter shoe inserts (orthotics) that provide cushioning and support to the feet. Orthotics can help distribute pressure more evenly and reduce strain on the Achilles tendon.
  • Stretch Regularly: Incorporate regular stretching exercises for your calf muscles and Achilles tendon. Proper flexibility can help reduce tension on the Achilles tendon attachment and minimize the risk of irritation.

Stretching legs and heel on steps

  • Maintain Healthy Footwear Rotation: Avoid wearing the same shoes every day. Rotating your footwear can reduce repetitive pressure on specific areas of the foot.
  • Choose Low-Impact Activities: Engage in low-impact exercises and activities that are gentle on the feet and minimize the risk of overloading the Achilles tendon and heel.
  • Pay Attention to Your Gait: Be mindful of your walking and running gait. Improper gait can lead to increased stress on the heel area. If you notice abnormalities in your gait, consider seeking advice from a physical therapist.
  • Maintain a Healthy Weight: Excess body weight can put additional strain on the feet and exacerbate conditions like Haglund's Deformity. Maintaining a healthy weight can reduce this strain.
  • Supportive Footwear During Activities: If you're engaging in sports or physical activities that involve running or jumping, wear shoes specifically designed for the activity. These shoes offer better support and cushioning for the feet.
  • Address Foot Issues Promptly: If you experience foot pain, discomfort, or notice any changes in your heel area, seek medical attention early. Timely intervention can prevent minor issues from developing into more serious conditions.
  • Regular Foot Care: Practice good foot hygiene and care. Keep your feet clean and moisturized, and regularly inspect them for any signs of irritation or abnormalities.

Remember that while these preventive measures can significantly reduce the risk of developing Haglund's Deformity, some factors like foot structure and genetics might still play a role. If you have concerns about your foot health or are at an increased risk due to your lifestyle or genetics, consider consulting a podiatrist or orthopedic specialist. They can provide personalized advice and recommendations based on your individual circumstances.

If you suspect you have Haglund's Deformity or are experiencing heel pain, it's important to consult a medical professional, such as a podiatrist or orthopedic specialist for an accurate diagnosis and personalized treatment plan. Early intervention can help prevent the condition from worsening and improve your overall quality of life.

For more info on other related foot conditions you can view our foot pain identifier.

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