Haglund's Deformity

Peter Wishnie, D.P.M.
Owner of Family Foot & Ankle Specialists in Piscataway & Hillsborough, NJ

Haglund deformity is commonly known as a "pump bump" or retrocalcaneal bursitis. It presents as a painful enlargement of the back of the heel bone that becomes irritated by shoe gear. The Haglund deformity presents as a red, painful, and swollen area in the back of the heel bone (calcaneus). Patients may also develop pain upon motion of the ankle joint and after activity, due to irritation of the Achilles Tendon. The syndrome usually occurs in females in the 2nd to 3rd decade, due to the irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone.


Causes:

The cause of Haglund Deformity is multifaceted. The underlying bony deformity can be present at birth, or acquired by injury over the patient's lifetime. A heel bone that has a bump on it's back surface is particularly vulnerable to injury by the hard back of a shoe. Shoe gear is the primary reason for the injury. The enlarged back of the heel rubs against the back of the shoe over and over again, causing the development of first, skin irritation and later, a bursitis, or inflamed fluid filled sac. That bursitis becomes the focus of pain and disability, making it impossible to wear shoes with backs.

 

Conseervative Treatment:
In mild cases of Haglund Deformity, changing the type of shoes can stop the injury and the consequent redness and swelling from developing. Soaking the foot may soothe the area and anti-inflammatories, Tylenol or Aspirin may diminish some of the pain. The pain can also be alleviated by placing a heel lift inside the shoe, to lift the Haglund Bump above the part of the heel counter of the shoe that rubs it.

 

Medical Treatment:
Your doctor will attempt one of a few simple therapies. In the mild cases, padding of the area may be indicated. Your doctor may recommend alternative shoe styles, including open back shoes. Oral anti-inflammatory medications and cortisone injections may also help to diminish the acute inflammation of the heel. Orthotics or arch supports may also be fabricated to prevent recurring symptoms. If conservative therapy fails, surgery will be utilized to correct this painful condition. Surgery consists of removal of the excess bone.

Prevention:

Altering your shoe style may be the only way to prevent the symptoms of Haglund Deformity from recurring. It is most important to avoid shoes with hard backs. If there is a large bony growth on the back of the heel, either shoe gear must be limited to only those with soft conforming backs, or the bump must be removed.