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Haglund’s Deformity

What Is Haglund’s Foot Deformity?
Haglund’s foot deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes.  This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

Haglund’s syndrome is a deformity of the foot. It is also known as “pump bump.” The condition arises when the bony section of your heel, where the Achilles tendon is located, is enlarged. Wearing shoes then puts pressure on the tissue at the back of your heel and causes inflammation. Eventually, this can lead to bursitis.

Bursitis is an inflammation of the fluid-filled sac that separates the tendon from the bone. When the heel becomes inflamed, it can lead to the calcification of the heel bone. This causes the bump to become even more prominent and increases your pain.

Haglund’s can develop in anyone. However, it is most common in people that wear stiff, closed-heel shoes, and in active children between the ages of 5 and 15.

With Haglunds Deformity, friction over the back of the heel causes the formation of bone spurs in heel.  These are when the body lays down extra layers of bone to try and protect itself.

The Achilles tendon runs down the back of the calf and attaches to the back of the heel bone, the calcaneus.  A bursa, a small fluid filled sac, sits in between the tendon and the heel bone to help prevent friction and allow the tendon to move smoothly. However, the bony prominence associated with Haglunds Deformity places excessive pressure on the bursa and it becomes inflamed, known as bursitis.  This can be extremely painful.

Causes
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, any shoes with a rigid back, such as ice skates, men’s dress shoes, or women’s pumps, can cause this irritation.

To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include:

A high-arched foot

A tight Achilles tendon

A tendency to walk on the outside of the heel.

The most common cause is footwear.  Shoes with rigid backs, like pumps, ice skates and high heels, place excessive pressure on the back of the heel, hence the alternative name for this condition, pump bump.  This can result in the formation of heel bone spurs, where extra layers of bone are laid down to try and protect the heel, forming the characteristic lump.  

Other causes of Haglunds Deformity include:

1)  Genetics: People with high foot arches are more prone to this condition as it causes the calcaneus to tip backwards increasing the pressure around the Achilles region

2)  Muscle Tightness: Tightness in the calf muscle places more tension on the Achilles tendon which increases the pressure on the bursa

3)  Walking Pattern: People who tend to walk on the outside of their feet are more likely to suffer from Haglund’s Deformity as it subtly changes the position of the heel bone increasing the friction under the Achilles tendon.

Symptoms
Haglund’s deformity can occur in one or both feet. The 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

The most common symptoms of Haglund’s Deformity are:

1)  A hard lump: found on the back of the heel, this develops gradually over time

2)  Swelling: there is often noticeable swelling around the back of the heel

3)  Redness: The back of the heel may look slightly red due to the inflammation of the bursa

4)  Pain: pain is usually felt at the back of the heel around the Achilles tendon.  It tends to be quite localised

How Does Haglund’s Syndrome Develop

Haglund’s is the result of frequent pressure on the backs of your heels. It may be caused by wearing shoes that are too tight and stiff in the heel.

People have different levels of risk for Haglund’s. Risk depends on the shape of the heel bone. Therefore, the condition tends to run in families.

What Are the Symptoms of Haglund’s Syndrome?

Haglund’s syndrome is very painful. It can develop in one or both feet.

Symptoms of Haglund’s include:

a very noticeable bump on the back of the heel

severe pain in the area where the Achilles tendon attaches to the heel

swelling in the back of the heel

redness near the inflamed tissue

How Haglund’s Disease Is Diagnosed

Haglund’s can be difficult to diagnose because the symptoms are similar to other foot issues like arthritis

Sometimes doctors can diagnose the condition by the appearance of the heel. If Haglund’s is suspected, you may receive an X-ray of your heel bone. This will help your doctor determine if you have the prominent heel bone associated with the disease

Your X-rays may also help your doctor shape orthotics to relieve your heel pain. Orthotics are customized shoe inserts made to stabilize your foot.

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.

Non-Surgical Treatment
Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following:

Medication. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce the pain and inflammation.

Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

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. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.

Shoe modification. Backless or soft backed shoes help avoid or minimize irritation.

Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation.

Orthotic devices. Custom arch supports control the motion in the foot.

Immobilization. In some cases, casting may be necessary.

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 shoes with a rigid heel back

Using arch supports or orthotic devices

Performing stretching exercises to prevent the Achilles tendon from tightening

Avoiding running on hard surfaces and running uphill.

Anatomy

What part of the foot is affected?

The calcareous (or heelbone) is the largest bone of the foot. The large Achilles tendon attaches to the back of the calcaneus. Between the bone and the Achilles tendon rests a bursa, a lubricated sac of tissue that allows the tendon to slide easily against the bone during movement of the foot. Bursae are found in many places in the body where tissues must move against one another.

Causes

Why do I have this problem?

The primary cause of Haglund’s deformity is pressure on the back of the heel from shoes. The calcaneus is shaped differently in different people. People who have a prominent bump underneath the attachment of the Achilles tendon are more likely to develop Haglund’s deformity. This prominent bump squeezes the soft tissues between the bone and the back of the shoe. Over time, this irritates the soft tissues and causes inflammation. This can cause swelling and thickening of the tissues, which makes the pressure even worse.

Symptoms

What does the condition feel like?

The primary symptom of Haglund’s deformity is pain at the back of the heel. Over time the tissues also usually thicken over the bone bump, causing a callus to form. The callus can grow quite thick and become inflamed while you are wearing shoes. The bursa on the back of the heel can become swollen and inflamed as well, causing bursitis. The bumps do not usually cause any problems with function, such as walking, except for the pain that occurs when the area is inflamed. 

Diagnosis

How do doctors identify the problem?

The diagnosis begins with a complete history and physical examination by your surgeon. Usually the condition is quite obvious from the appearance of the back of the heel. X-rays will usually be required to allow the surgeon to see how the calcaneus is shaped and to make sure there is no other cause for your heel pain. Generally no other tests are required.

Treatment

What can be done for a Haglund’s deformity?

Treatment of Haglund’s deformity can be divided into nonsurgical treatment and surgical treatment. In the vast majority of cases, treatment usually begins with nonsurgical measures. Surgery usually is considered when all other measures have failed to control your problem and the pain becomes intolerable.

Nonsurgical Treatment

The primary cause of the problem is shoe wear. The shape of the calcaneus probably would not matter much if we all went barefoot. One easy way to remove the pressure from the back of the heel is to wear shoes with no back, such as clogs. If you must wear shoes with backs, pads placed over the back of the heel may give some relief. Staying out of shoes as much as possible will usually reduce the inflammation and the bursitis due to Haglund’s deformity.

Surgery

Several surgical procedures have been designed to treat Haglund’s deformity. The goal of these procedures is to reduce the prominence on the back of the heel so that the pressure from the shoe does not occur. Over time the thickened tissues will shrink back to near normal size if the pressure is removed.

Bump Removal

Many surgeons simply remove the bump. This procedure is done through a small incision on the back of the heel. The Achilles tendon is retracted (moved away) so that the surgeon can see the back of the calcaneus. Some bone is then removed, and the calcaneus is shaped and rounded so that the pressure does not occur. The incision is closed with stitches, and you are placed in a bulky bandage to protect the foot while it heals. You may be placed in a splint from the knee to the toes.

Wedge Osteotomy

Another way to accomplish the same thing is to take out a wedge of bone from the calcaneus, shortening it. This is referred to by surgeons as a wedge osteotomy. This procedure is performed much the same as removing the bump.

Rehabilitation

What should I expect following treatment?

Nonsurgical Rehabilitation

Patients with an inflamed and painful Haglund’s deformity may benefit from four to six physical therapy treatments. Your therapist can offer ideas of pads or cushions that help take pressure off the back of the heel. You might get recommendations on shoes that keep pressure off the sore area.

These simple changes to your footwear may allow you to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside.

Treatments directed to the painful area help control pain and swelling. Examples include ultrasound, moist heat, and soft-tissue massage. Therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area.

After Surgery

You may require crutches for a few days after surgery. A physical therapist or nurse may teach you how to properly use your crutches.

The incision is protected with a bandage or dressing for about one week after surgery. The stitches are generally removed in 10 to 14 days. However, if your surgeon chose to use sutures that dissolve, you won’t need to have the stitches taken out. You should be released to full activity in about six weeks.

How Is Haglund’s Treated?

Treatment for Haglund’s usually focuses on relieving pain and taking pressure off the heel bone.

Non-surgical options include:

wearing open-heel shoes, such as clogs

NSAID pain relievers, like Tylenol 

icing for 20 to 40 minutes a day to reduce swelling

Iontophoresis, which uses a weak electrical current to help anti-inflammatory drugs penetrate the skin. Ultrasound treatments, moist heat, soft tissue massage, orthotics heel and cushion pads to reduce pressure from shoes

Surgery can also be used to treat this condition if less invasive methods fail. During surgery, the doctor will remove the excess bone from your heel. The bone may also be smoothed and filed down. This reduces the pressure on the bursa and soft tissue.

After surgery, it will take up to eight weeks for you to heal. Your doctor will normally provide you with a wooden shoe or cast to protect your foot. You may also need to use crutches for a few days.

The cut will remain bandaged for seven days. Within two weeks, your stitches will be removed. Doctors will X-ray your foot on follow-up visits to ensure it is healing properly. 

How to Prevent Haglund’s Syndrome

You can reduce your risk of Haglund’s by taking good care of your feet. Try to:

avoid shoes with tight, stiff heels, wear shoes without backs, wear fitted, padded socks with non-slip soles, perform stretching exercises to prevent tightening of the Achilles tendon avoid running on hard surfaces or uphill

What is Haglund’s Deformity?

Haglund’s Deformity is a bony enlargement of the back of the heel bone. Sometimes it’s called “pump bump” because the deformity often occurs in women who wears pumps.

Causes

The shape of your foot can contribute to the development of Haglund’s Deformity. If you have high arches, a tight Achilles tendon, or a tendency to walk on the outside of your feet, you’re more likely to develop Haglund’s Deformity than other people. Wearing shoes with a firm, rigid back may also contribute to the development of Haglund’s Deformity.

Symptoms

The primary symptoms of Haglund’s Deformity are an enlarged bony prominence on the back of the heel and heel pain. You might also develop blisters on your heels as a result of your shoes rubbing against the bump.

Home Care

Heel pads placed in the backs of your shoes may relieve and redistribute some of the pressure. Applying ice to the area after removing your shoes may ease some of the pain and discomfort. Switching shoes can help, too. If you have an otherwise normal foot, wearing open-heeled shoes may provide relief. Open-heeled shoes are not a good idea, though, if you have tendinitis, bunions, foot pain, or a structural deformity of the foot.

When to Visit a Podiatrist

If the pain persists despite your home remedies, or if the bump continues to enlarge, it’s time to see a podiatrist. A podiatrist can carefully evaluate your feet and create a treatment plan tailored to your feet. 

Diagnosis and Treatment

A podiatrist will begin by carefully examining your feet and taking a thorough medical history. X-rays may be ordered to get a good look at the structure of your feet. Sometimes, an MRI or ultrasound might be ordered as well.

Treatment will depend on the severity of the condition.

Options include:

Shoe modification. Your podiatrist can recommend over-the-counter heel pads, heel lifts, or arch supports, or create custom orthotic supports to change the position of your feet in your shoes to relieve pressure on the back of your foot.

Medication. Topical anti-inflammatory medication, applied directly to the heel, may provide pain relief. Oral anti-inflammatory medication (such as ibuprofen) can help as well.

Immobilization. If the area is extremely inflamed, a custom-made soft cast or walking boot may be used to immobilize the area and allow it to heal.

Surgery. If none of the non-surgical methods provide adequate relief, your podiatrist may recommend surgery to correct the deformity. Podiatrists are specially-trained foot and ankle surgeons who can surgically re-shape the heel bone.

Prevention

Avoid shoes with rigid backs. If you have a high arch or tight Achilles tendon, wearing appropriate shoe inserts and/or adequately stretching the Achilles tendon can help prevent the development of Haglund’s Deformity.

Haglund’s Deformity / Bauer Bump / Pump Bump / Retrocalcaneal Bursitis

Haglund’s deformity, also known as pump bump or Bauer bump, is a condition where a bony enlargement on the back of the heel forms, and it leads to retrocalcaneal bursitis which can become quite painful and irritated if the area rubs up against any type of footwear. It is called “pump bump” as the condition often occurs because of the pump-style shoes that many women wear. The rigid backs of the shoes create the pressure that irritates that area of the heel, and women who wear pumps are the most common sufferers of this condition.

Treatment & Prevention

Treatment initially aims to reduce the inflammation in the bursa and will depend on what caused the condition to develop in the first place:

1)  Footwear: Wearing backless, soft-backed shoes or going barefoot helps reduce the friction around the area and is one of the best ways to treat of prevent Pump Bump

2)  Heel Pads: You can place soft pads on the back lip of your shoe to cushion the heel, or underneath the heel to lift it up and reduce the pressure when walking 

3)  Stretches: Calf stretches helps reduce the tightness and tension in the Achilles tendon and are a great way to treat and prevent this condition.  You can suitable exercises in the calf stretches section

4) Ice: Ice can be used to help reduce the pain and inflammation around the area.  Find out how to safely and effectively use ice in the Ice Therapy section

5) Medication: NSAIDs (non-steroidal anti-inflammatory drugs) can be used to reduce the pain and inflammation associated with Haglund’s Deformity.  Some people prefer to use the cream form and rub it into the back of the heel instead of taking pills.  Always check with your doctor before taking any medications

6)  Physical Therapy: Treatment such as ultrasound can help to reduce the inflammation associated with bursitis

7)  Changing Activities: Avoiding running on hard surface and try and keeping on the flat rather than going uphill can help prevent Haglunds Deformity

Often, these treatments are enough to cure the pain and inflammation associated with pump bump, although there may still be a lump on the back of the heel.  

If symptoms persist, surgery may be required.  Most commonly, as small incision is made and the surgeon removes the heel bone spurs, leaving a nice, flat surface. Sometimes, they may also have to remove the bursa and part of the Achilles tendon.  You may need to use crutches for a few days following surgery.

Haglund’s Deformity Symptoms

The first Haglund’s deformity symptoms begin with the enlargement of the bone prominence on the heel’s back. It is usually seen it that very area, where the Achilles tendon attaches the heel. As a rule, the bump is very painful, especially, when a person wears tight shoes. It becomes swollen or red, may form a bursa, that later becomes inflamed.

There are absolutely various causes of Haglund’s deformity, but most of them a structural. Some people have problems, because they have inherited them, when they were born. Among other vital factors are the increase in weight, improper shoes, injuries, and various activities, which can change the foot functions.

When you feel pain in the heel’s back, you should address your doctor immediately, because it’s one of the Haglund’s deformity symptoms. But when you are reading this article having no such problems yet, you should take some preventive measures. Wear padding or shoes to reduce the area friction, use ice as it reduces pain.

Understanding Haglund’s Deformity

People with Haglund’s deformity usually experience Achilles tendon irritation, they feel tightness and disorder while walking or running. In case one has a rather tight tendon, then various stretching exercises can play a great role in the deformity treatment.

When one is free of the problem now, that doesn’t mean he is protected. Prevention is the best cure, and some exercises can become helpful. In such cases many people use Achilles tendon exercises that stop deformation process. Other additional steps are avoiding running on hard surfaces, wearing comfortable shoes with arch supports, massages and ice therapies.

There are various ways and options to choose from, but many podiatrics choose a conservative care. To follow this program correctly, one should avoid high heel shoes. Usually flip-flops and clogs are rather helpful and reduce the amount of direct pressure. One more popular way out in case of pain is anti-inflammatory medicine. They cease pain – the primer cause of Haglund’s deformity.

4 Ways To Treat Haglund’s Deformity

We have already mentioned that preventive measures are desirable as they are rather effective, but what to do if you missed that step and faced deformation problems? There are four basic ways out.

1. PRICE Plan

P – rotection
R – est
I – ce
C – ompression
E – levation.

The illness starts with inflammation, and a person starts feeling pain and stiffness near the top of the heel bone. That happens more frequently in the morning. If you start treating inflammation on early stages, you will manage Haglund’s deformity easily. Try to stop performing those activities that cause pain and swelling. Put ice packs several times per day and keep them for 20 minutes 

2. Different Shoes

In 50% of cases shoes are the primer cause. Constant pressure and rubbing of the shoes cause irritation. This is the usual thing, especially for women. That is why one should be very careful with this. The tendon can also be affected, so try various shoes. They should not rub against the back of the heel.

3. Move Again

Runners are prone to tendinitis because of overstretching and overuse of the tendon. When you appear to be out of the inflammatory phase, you can try wearing a heel pad and various orthotic devices in running shoes for some time.

4. Surgery And Injections

When a person has Haglund’s deformity and basic treatments do not help, one needs surgical interference or injections. After the surgery, the foot will be immobilized for a definite period of time.

Many doctors advise their patients various injections to relieve the bursa inflammation. There exist various additional methodics, like ultrasound. Some people say that it results in fewer drawbacks.

They say that steroid injections must be avoided, because of various possible complications. However, steroids that are used in iontophoretic applications may be effective. In this case doctors use a 3 volt current that transduces the dexamethasone cationic structure to the inflamed tissue through the dermis. Besides, here the concentration is slow and low.

Podiatric care reduces bump pressure, which has been already formed. Good shoes won’t help you to get rod of the problem on the last stage. You may be advised to wear inserts for the shoes you have. These insets are not difficult to find, as they are available in any drug store.

Before you decide to use surgical interference, think twice. Not all cases are severe, and you can avoid an operation if you take medicine, make massages and use ice and heat therapies. Haglund’s deformity can be solved in many other ways, and surgery is not the only way out.

Haglunds Deformity is an enlargement of part of the bone on the back of the heel which irritates the soft tissues around the Achilles tendon and causes heel pain.  It is also known as Pump Bump or Mulhulland Deformity. 

You may be genetically disposed to Haglund’s Deformity by your foot shape, or it can be caused by muscle tightness or friction from shoes.

Here, we will look at the causes, symptoms, associated problems and treatment options for these uncomfortable heel bone spurs.

Other Causes of Heel Pain

If you are getting pain around the back of the heel, but it is not sounding quite like Haglunds Deformity, it may be that you have a problem in the Achilles tendon – visit the Achilles Tendonitis section to find out about the common causes, symptoms and treatment options for this common cause of heel pain. 

Alternatively, visit the heel pain diagnosis section for help working out what is causing your pain.