What Is A Haglund’s Deformity, AKA “Pump Bump?”
A Haglunds deformity is a bony enlargement of the back of the heel where the Achilles tendon attaches to the heel bone. A Haglunds deformity is colloquially referenced as a “pump bump,” because the rigid backs of pump-style shoes can result in excessive pressure that aggravates the enlargement while walking. Patients will typically report pain in the back of the heel, heel swelling, and a painful bony lump along the posterior heel.
What Causes Haglund’s Deformity?
Although there are many theories as to why a Haglunds deformity occurs, it would appear that most causes are related to a patient’s inheritable genetic foot structure. Features such as excessively high arches, a tight heel cord (Achilles tendon), or lack of flexibility can lead to a painful bony bump. Some theorize that a Haglunds deformity will result from frequent irritation of soft tissue. Wearing shoes such as ice skates, men’s dress shoes, or stiff winter boots can lead to rubbing of the soft tissue on the posterior heel and result in a painful bursa. A bursa is a fluid filled sac of inflammatory cells that will develop between the Achilles tendon and the bone.
Symptoms Of A Haglund’s Deformity
The most common symptoms associated with a Haglunds deformity are foot pain, heel redness, swelling, difficulty with different types of shoe gear, and of course, a prominent heel bone. Patients with a history of Achilles tendonitis can be at an increased risk of developing Haglund’s syndrome.
How To Diagnose Haglund’s Deformity
The easiest, fastest, and most inexpensive way to diagnose a Haglund’s deformity is with an Xray. When a patient presents to their podiatrist’s office, the physician will take a comprehensive history, perform a physical exam, and will likely have a basic series of radiographs obtained. Although Xrays are not indicated for evaluation of soft tissues such as the previously mentioned bursa or Achilles tendon, they are exceptionally useful in evaluating osseous structures. On Xray, bone spurs, or an enlarged bony prominence can easily be seen adjacent to the insertion of the Achilles tendon.
Treatment For A Haglund’s Deformity
A Haglund’s deformity can be treated by either conservative or surgical approaches. Similar to most pathologies, the physician will likely determine a treatment plan based on the severity of the deformity, the patient’s pain level, the patient’s lifestyle, recovery timeline, and goals/expectations for treatment. In some instances, simple treatments such a change in shoegear, or use of orthotic devices can provide pain relief, however in more severe cases, surgery may be indicated.
A Haglund’s deformity treatment plan often requires a multi-modal approach. Understanding that the posterior heel pain is often a secondary result of an excessively tight Achilles tendon, patient’s may respond well to initiating physical therapy or an aggressive stretching regimen. To decrease the mechanical pull and relieve tension on the Achilles tendon, heel lifts may be utilized. Other options may include shoe inserts, immobilization in a CAM boot, or oral anti-inflammatories. Some patient’s that continue to have pain may require a shoe modification such as soft backed shoes, or heel pads to reduce irritation of the adjacent bone and soft tissues. An Achilles gel sleeve is a useful over the counter product that can wrap around your ankle, providing adequate padding to the heel bone and the surrounding soft tissue.
In patients that fail to respond to conservative therapies, surgery may be indicated. One of the most common surgical approaches entails detachment of the Achilles tendon entirely, with subsequent resection of the bony prominence (AKA retrocalcaneal exostosis). After the excess bone is resected, the Achilles tendon is reattached to the remaining heel bone with suture anchors, and if necessary the Achilles tendon is repaired with a non-absorbable suture. Haglund’s deformity surgery can be relatively extensive and take several months. Immediately after the surgery the patient will be placed into a below the knee cast or splint, and will be made non-weightbearing for 4-6 weeks. Next, the patient will likely be transitioned into an immobilizing CAM boot and the non-weightbearing status will continue for an additional 2-4 weeks. At approximately 8-12 weeks postoperative, weightbearing in a walking boot with passive range of motion exercises can be initiated. After this period is completed, the patient can be slowly transitioned back into a supportive shoe. After all surgery has been completed, some patients may require physical therapy, stretching exercises, and possibly even supportive shoes with arch supports.
Tips to Prevent Haglund’s Deformity
Just like any other foot pathology, it is imperative to never ignore foot pain. Listening to your body’s natural feedback system can prevent issues from worsening. Utilize arch supports tailored to your foot structure, and avoid shoes with rigid backs to prevent further irritation to the back of the heel. Eccentric stretching exercises that are directed toward lengthening of the calf muscle can help prevent Achilles tendinitis as well as a host of other Achilles tendon disorders.
When To Make A Visit With Foot and Ankle Surgeons?
Foot and ankle surgeons can provide valuable feedback on pain reduction strategies, as well as a comprehensive surgical workup. Once a patient’s pain grows to the point where it is consistently interfering with day to day life, it is essential to seek treatment. Your physician will be able to effectively communicate all treatment options such as heel lifts, possible appropriate shoe inserts, or even resection of the bony enlargement. Understanding all of your treatment options and the etiology of Haglund’s deformity is imperative to making a full recovery. Treat your foot and ankle to the care they deserve and make appointment today.
Make An Appointment With Cutting Edge Foot and Ankle Today!
Are you having problems with a painful bony spur at the back of your heel? Have you recently discovered a noticeable bump and are interested in ways to decrease your heel pain? Call Cutting Edge Foot and Ankle Clinic at 615-866-9639 today. We are available for same day appointments and look forward to keeping you on your feet!