Haglund's Deformity (Back of Heel Bump)

Haglund's deformity is a bony bump where your Achilles tendon attaches at the back of your heel bone. Also known as a "pump bump," it is usually caused by shoes repetitively rubbing against your heel. Because of its prominence, the bump is subject to constant friction, causing redness, pain, swelling, and callouses.

Abnormalities in your gait or foot position—along with the types of shoes you wear—can contribute to the deformity. Treatments tend to be conservative but may involve surgery if the bump is affecting your mobility or causing undue pain.

This article explains the symptoms and causes of Haglund's deformity, including how it is diagnosed and treated.

Haglund's Deformity

What Are the Symptoms of Haglund's Deformity?

Haglund's deformity usually affects both feet rather than just one given that the shoes you wear contribute to the deformity.

The primary symptoms of Hagund's deformity are:

• A large bony bump on the back of your heel
• Pain where the Achilles tendon inserts into the calcaneus (heel)
• Swelling in the back of the ankle due to bursitis (inflammation of cushioning sacs called bursae)
• Swelling of the Achilles tendon caused by tendonitis (tendon inflammation)
• Symptoms that worsen when wearing rigid or poorly fitting shoes
• Blisters or callouses on or around the bump

Over time, progressive damage to the Achilles tendon can cause it to degenerate, leading to tendinosis.

What Causes Haglund's Deformity?

Haglund’s deformity tends to affect people over 40 but can also affect younger people who wear inappropriate footwear. Females are affected more than males (due in part to the wearing of high heels).

Haglund’s deformity is caused by repetitive stress placed on the spot where the Achilles tendon inserts into the back of the heel bone. The constant rubbing and friction place stress on the bone that the body tries to repair by modeling new bone atop old bone. Over time, this can lead to the formation of a bump.

Risk factors for Haglund's deformity include:

• Shoes with high arches
• Tight, poor-fitting shoes
• Shoes with rigid backs (like high heels, work boots, and dress shoes)
• A tight Achilles tendon
• A tight gastrocnemius (calf) muscle
• Foot supination (walking on the outside of your foot)
• Overtraining for running, ice skating, or other similar sports

How Is Haglund's Deformity Diagnosed?

If you have Haglund's deformity, your primary healthcare provider may refer you to a foot specialist known as a podiatrist.

Haglund's deformity can often be diagnosed by appearance alone. Even so, the podiatrist will want to identify the cause of the deformity and may ask you questions about the types of shoes you wear, the nature of your work, or the types of sports you play.

You may also be given a gait analysis during which the podiatrist will watch you walk to see if you have foot supination, foot overpronation (walking on the inside of your foot), high steppage gait (walking on the balls of your feet), or other walking abnormalities.

Imaging tests may also be used to look at the structure of your foot:

• X-ray is able to detect problems with bones and larger structures of the foot.
• Magnetic resonance imaging (MRI) is better at imaging soft tissue like tendons and bursa.

Differential Diagnosis

Haglund's deformity is sometimes mistaken for other causes of rear foot pain. Because of this, your healthcare provider may order other tests to rule out conditions with similar symptoms, such as:

• Ruptured Achilles tendon
• Plantar fasciitis
• Heel fracture
• Seronegative spondyloarthropathies

How Is Haglund's Deformity Treated?

Many conservative treatments are available to help ease the pressure, pain, and inflammation caused by Haglund's deformity. They don't shrink the bony protrusion, but that's generally not needed. The earlier the condition is diagnosed and treated, the better your chances of a full recovery without surgery.

Conservative Treatments

With Haglund's deformity, reducing pressure and friction at the site of a pump bump is essential. You can do this by wearing shoes that fit well, conform to your foot structure, and support the heel without constricting it. Your podiatrist can refer you to footwear specialists who can help.

Other first-line options for Haglund's deformity include:

• Ice application for 10 to 15 minutes to reduce acute swelling and pain
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) or Aleve (naproxen)
• Heel pads to reduce friction and irritation
• A night splint to support the ankle and foot at night
• Heel lifts to decrease pressure on the heel for people with high arches
• Backless or soft-backed shoes
• Foot orthotics to correct supination
• Physical therapy exercises for the Achilles tendon
• Physical therapy exercises for the ankle
  
• A cast or walking boot for severe cases
• Therapeutic ultrasound
  

Surgery

If conservative treatments don't provide adequate relief, surgery may be needed. Surgery for Haglund's deformity is typically done as an outpatient procedure, meaning you will be able to go home on the same day.

One common option is endoscopic calcaneoplasty used to remove the bony bump. This minimally invasive surgery is performed under local or regional anesthesia with two tiny incisions, a flexible fiber-optic scope, and specialized, tube-like surgical equipment.

Less commonly, calcaneoplasty is performed as an open surgery with a scalpel and a large incision.

Recovery from the operation takes 8 to 12 weeks depending on the extent of the surgery. After two weeks, the walking boot is removed, and weight-bearing walking can gradually start. By 4 to 6 weeks, most people can walk without restriction but need to avoid injuring their heel and ankle.

Complications are uncommon but may include ankle tightness or weakness. Physical therapy can help remedy these concerns.

If adequate bone is removed during the calcaneoplasty, Haglund’s deformity rarely recurs.

Summary

Haglund's deformity describes a bony bump on the foot that is usually caused by years of wearing stiff, tight, or ill-fitting shoes. Over time, the repetitive stress can cause abnormal bone formation on the heel, causing pain, swelling, and inflammation.

Haglund's deformity can often be diagnosed by its appearance alone. Treatments include heel pads, foot orthotics, ice application, and physical therapy. If these measures don't help, surgery may be recommended.