What is Haglund’s Deformity?
Hearing this you may think “what! I have a deformity?” However, it’s not as bad as it sounds.So what is it really? Also referred to as Achilles bursitis, Haglund’s deformity is an enlargement of the bone on the back of the heel, which often leads to painful bursitis, that is, an inflamedbursa. The bursa is a fluid-filled sac between the Achilles tendon and the heel bone.
Who gets it?
The condition typically occurs in young, active individuals, as well as those with high arched feet, since the heel bone (calcaneus) tilts back in a high arched foot. As the heel bone tilts back, the bump on the back of the heel becomes more prominent.
Women who wear ill-fitting shoes are also risk, which has given rise to the condition being known colloquially as the “pump bump”. Men wearing boots can develop it by the side of the foot.
When shoes rub on the bony prominence inflaming the bursa and the surrounding tissues, the prominence also presses against the Achilles tendon, causing irritation in the area.
The “pump bump” commonly occurs when we wear our ‘beloved’ high heels, also called pumps. The combination of the rigidity of the heel counter, and the foot and ankle position in a high heeled shoe, tend to cause excess rub and irritation to the back of the heel. As one podiatrist rightly observed, “high heels are always an issue”!
A tight Achilles tendon could contribute to the development of the condition by increasing the rub and irritation on the bursa. Individuals who walk on the outside of their heel may be prone too to this condition because the rotation of the heel increases friction to the area.This biomechanical defect, which can be a heredity factor, produces wear on the outer edge of the sole of the shoe, causing the heel to rotate inward, resulting in a grinding of the heel bone against the tendon. The tendon protects itself by forming a bursa, which eventually becomes inflamed and tender.
Haglund’s deformity can occur in one or both feet. The signs and 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
Conservative therapy or non-surgical treatment is always tried initially, aimed at reducing the inflammation of the bursa and surrounding tissue; and while these approaches can resolve the bursitis, they will not shrink the bony protrusion.
Non-surgical treatment can include one or more of the following, as recommended by your doctor/chiropodist/foot health practitioner:
- Icing –use an ice pack or a bag of ice wrapped in a towel and massage the inflamed area for 15-20 minutes a few times daily.
- Anti-inflammatory medications – may help reduce the pain and inflammation.
- Calf Stretches – individuals with a tight calf will benefit from a daily routine of calf stretching.
- Heel lifts – individuals with high arches or with a tight calf may benefit from heel lifts placed inside the shoe.
- Padding – placing pads directly on the heel, heel cups or heel hugs (around the area of inflammation) or inside the back of the shoe will help to disperse the pressure. For shoes with rigid heels, a soft pad placed on the heel counter will decrease irritation.
- Shoe modifications – wearing shoes with soft backs or that are backless will decrease the pressure, friction and rub on the back of the heel.
- Physical therapy – ultrasound and other modalities can help to decrease localised inflammation.
- Orthotics -arch supports control abnormal motion in the foot helping to decrease the excess rub and irritation on the back of the heel.
- Casting/Immobilisation -in some cases, this may be necessary to reduce symptoms.
When Is Surgery Needed?
If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The orthopaedic 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.
- The patient is allowed to walk with the help of crutches and avoid bearing weight onthe operated foot for the next 3 weeks.
- The operated foot should be elevated for at least 3 to 5 days.
- The surgical wound should heal within 14 days after surgery and the stitches are removed.
- The patient can start putting more weight on the operated foot from 3rd week onwards.
- Running can resume in 3 months’ time.
- The success rate of this procedure has been quoted to be 90%.
A recurrence of Haglund’s deformity may be prevented by:
- Avoiding pumps, high-heeled shoes or those with stiff backs
- Using shoes that pad the area that rubs against the Achilles tendon, and have padded rubber soles at the heel and the balls of the feet
- Using arch supports or orthotic devices
- Performing stretching exercises to stop the Achilles tendon from tightening
- Avoiding running on hard surfaces and running uphill.
The best treatment for Haglund’s deformity is to catch it early and make whatever changes are necessary to bring it under control.
Your feet mirror your general health . . . cherish them!