Haglund’s Deformity: Symptoms, Causes, Treatment

What are the symptoms of Haglund’s deformity?

Haglund’s deformity, also known as pump bump or retrocalcaneal bursitis, typically presents with the following symptoms:

1. Bony prominence: There is a noticeable bump on the back of the heel bone (calcaneus). This bump can be sensitive to touch and can cause irritation due to shoe pressure.
2. Pain and tenderness: Pain is usually felt where the Achilles tendon attaches to the heel bone. This pain can be sharp or dull and may worsen with activity, especially with tight-fitting shoes.
3. Swelling: The area around the Achilles tendon insertion may appear swollen or inflamed.
4. Redness and warmth: Inflammation can lead to localized redness and warmth around the affected area.
5. Limited ankle motion: Some individuals may experience stiffness or limited range of motion in the ankle joint, especially in dorsiflexion (pulling the foot up towards the shin).
6. Symptoms worsen with activity: Pain and discomfort often increase during activities that involve repetitive ankle motion, such as running or jumping.

If you suspect you have Haglund’s deformity or are experiencing these symptoms, it’s advisable to consult with a healthcare provider for proper diagnosis and treatment recommendations.

What are the causes of Haglund’s deformity?

Haglund’s deformity is primarily caused by a combination of anatomical factors and repetitive irritation of the heel bone (calcaneus) and Achilles tendon. The main causes include:

1. Anatomical factors: Individuals with a prominent or enlarged bump on the back of the heel bone (calcaneus) are more prone to developing Haglund’s deformity. This bony prominence can create friction and irritation when shoes rub against the heel.
2. Tight-fitting shoes: Wearing shoes that press against the back of the heel can exacerbate the problem. High-heeled shoes, in particular, can increase pressure on the Achilles tendon and heel bone.
3. High-arched feet: People with high arches (cavus foot) may be more susceptible to developing Haglund’s deformity due to the way their foot mechanics interact with shoe wear.
4. Biomechanical factors: Abnormal foot biomechanics, such as overpronation (excessive inward rolling of the foot) or supination (underpronation), can contribute to increased pressure on the heel and Achilles tendon.
5. Repetitive activities: Activities that involve repetitive ankle motion or sudden increases in physical activity can irritate the Achilles tendon and exacerbate the condition. This includes activities like running, jumping, or wearing shoes that continuously rub against the heel.
6. Genetic predisposition: Some individuals may have a genetic predisposition to developing Haglund’s deformity due to inherited foot structure or biomechanical issues.

Understanding these causes can help in managing and preventing Haglund’s deformity by addressing footwear choices, foot biomechanics, and reducing repetitive stress on the Achilles tendon and heel bone.

How is the diagnosis of Haglund’s deformity made?

The diagnosis of Haglund’s deformity typically involves a combination of medical history, physical examination, and sometimes imaging studies. Here’s how it is usually diagnosed:

1. Medical history: Your healthcare provider will ask you about your symptoms, including any pain or discomfort in the back of the heel, swelling, and aggravating factors such as certain types of footwear or activities.
2. Physical examination: During the physical exam, your healthcare provider will inspect the back of your heel for the presence of a prominent bump. They will also palpate (feel) the area to assess for tenderness, swelling, and signs of inflammation around the Achilles tendon insertion.
3. Gait analysis: Your provider may observe your gait (walking pattern) to assess for any abnormalities in foot mechanics that could contribute to Haglund’s deformity.
4. Imaging studies: X-rays are commonly used to confirm the diagnosis and assess the extent of the deformity. X-rays can show the bony prominence on the back of the heel bone and any associated calcifications or changes in the Achilles tendon attachment area. In some cases, additional imaging such as ultrasound or MRI may be recommended to further evaluate soft tissue involvement and inflammation.
5. Differential diagnosis: Haglund’s deformity may resemble other conditions that cause heel pain, such as Achilles tendinitis, retrocalcaneal bursitis, or heel spurs. Your healthcare provider will differentiate Haglund’s deformity from these conditions based on clinical findings and imaging results.

Once diagnosed, treatment options can be discussed based on the severity of symptoms and the impact on daily activities. It’s important to consult with a healthcare professional for an accurate diagnosis and appropriate management plan.

What is the treatment for Haglund’s deformity?

Haglund’s deformity is a type of bony prominence on the heel of the foot, also known as the retrocalcaneal bursitis. The treatment for Haglund’s deformity typically depends on the severity of the condition and the individual’s symptoms. Here are some common treatment options:

1. Conservative treatments:
   • Foot orthotics: Custom-made shoe inserts or arch supports can help reduce pressure on the affected area.
   • Shoe modifications: Wearing shoes with a soft, cushioned collar and a wider toe box can help reduce friction and pressure.
   • Stretching and exercises: Stretching the calf muscles and Achilles tendon can help alleviate tension and relieve pressure on the heel.
   • Ice and heat therapy: Applying ice packs to reduce inflammation and heat to relax muscles can help relieve pain and discomfort.
2. Surgical treatments:
   • Excision of the bursa: Removing the inflamed bursa sac can provide relief from pain and inflammation.
   • Soft tissue release: Releasing tension in the surrounding soft tissues, such as the Achilles tendon and plantar fascia, can help alleviate pressure on the heel.
   • Osteotomy or excision of the deformity: In severe cases, surgical correction of the bony deformity may be necessary to reduce pressure on the surrounding tissues.
3. Physical therapy:
   • Physical therapy can help improve flexibility, strength, and range of motion in the ankle and foot, reducing tension and pressure on the affected area.
4. Night splints:
   • Wearing a night splint can help stretch the calf muscles and Achilles tendon while you sleep, reducing stiffness and discomfort upon waking.
5. Corticosteroid injections:
   • Injecting corticosteroids into the affected area can help reduce inflammation and relieve pain.

It’s essential to note that not all individuals with Haglund’s deformity require surgery. Mild cases may respond well to conservative treatments, while more severe cases may require surgical intervention. A healthcare professional, such as an orthopedic specialist or podiatrist, should evaluate your condition and recommend a personalized treatment plan.