What is Haglunds Deformity?
What is the Haglund's Deformity?
Haglund's Deformity is an enlargement of the bone on the back of the heel also known as "retrocalcaneal bursitis" that most often leads to painful bursitis because it becomes irritated by shoes. In Haglund's Deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against the shoes being worn.
It normally appears as a red, painful, and swollen area in the back of the heel bone. Women tend to develop the condition more than men because of the irritation from rigid heel counters of shoes rubbing up and down on the back of the heel bone. Another name for Haglund's Deformity is "pump bump". The rigid backs of the pump-style shoes can create pressure that aggravates the bone enlargement when walking. Haglund's Deformity is most common in young women who wear pumps often.
What causes Haglund's Deformity and how is Haglund's Deformity diagnosed?
To some extent, heredity plays a role in this deformity. Some people can inherit the bone structure that makes them prone to developing Haglund's Deformity. High arches is a major factor of this deformity. The Achilles tendon attaches to the back of the heel bone. With having high arches, the heel is tilted backward into the Achilles tendon. This would cause the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to thia 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 attribute to Haglund's Deformity, causing pain by compressing the tender and inflamed bursa. In contrast, a flexible tendon would cause less compression against the 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 from forming a bursa, which eventually becomes inflamed and tender.
The patient is evaluated after the symptoms are explained and the foot will be examined. In addition, X-Rays will be ordered to help better evaluate the structure of the heel bone.
Haglund's Deformity symptoms include:
- The most apparent symptom of the deformity is a noticeable bump on the back of the heel.
- Pain in the area where the Achilles tendon attaches to the heel bone.
- Swelling in the back of the heel and redness near the inflamed tissue.
How can Haglund's Deformity be prevented?
A reoccurence of Haglund's Deformity can be prevented by wearing the appropriate shoes and preventing pumps and high-heeled shoes. Using arch supports and orthotic devices in the shoes helps reduce the occurrence of Haglund's Deformity. Loosening the Achilles tendon by performing stretching exercises and avoid running on hard surfaces and uphills will also help prevent Haglund's Deformity as well.
Treatment normally includes nonsurgical procedures that are aimed at reducing the inflammation of the bursa. While these procedures help with the bursitis, they will not shrink the bony protrusion on the back of the heel. Nonsurgical treatments include one or more of the following:
- Anti-inflammatory medications may help reduce the pain and inflammation. Some patients also find the topical pain reliever applied directly over the inflammation site beneficial.
- Ice on the inflamed area to help reduce the swelling for 20 minutes upon waking in the morning. However, do not apply the bag of ice directly to the skin. Instead place a thin towel between the ice and the area its applied to.
- Stretching exercises assigned by Dr. Neuhaus to help relieve tension of the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord. Some of these exercises can be viewed on the basic exercises video or shown on the stretching handout. Physical Therapy may also reduce some inflammation with ultrasound therapy along with exercise education.
- Patients with high arches may find that heel lifts placed inside their shoes help decrease the pressure on the heel. Also placing heel pads inside of the shoes will cushion the heel and may reduce irritation while walking.
- Immobilization of the foot and ankle by a cast or brace may help in some cases.
- Shoe modifications are helpful with Haglund's Deformity. Wearing shoes that are backless or have soft backs will help avoid or minimize irritation.
- Orthotic devices contain custom arch supports are helpful because they control the motion in the foot which can aggravate the symptoms.
Copyright © 2006, American College of Foot and Ankle Surgeons.