Haglund’s deformity is a bony enlargement on the back of the heel that most often leads
to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the
tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon
becomes irritated when the bony enlargement rubs against shoes.
Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style
shoes can create pressure that aggravates the enlargement when walking. In fact, the
deformity is most common in young women who wear pumps.
Haglund’s deformity can occur in one or both feet. The signs and symptoms include:
- A noticeable bump on the back of 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.
To some extent, heredity plays a role in Haglund’s deformity. People can inherit a type
of foot structure that makes them prone to developing this condition.
For example, high arches can contribute to Haglund’s deformity. The Achilles tendon
attaches to the back of the heel bone, and in a person with high arches, the heel bone is
tilted backward into the Achilles tendon. This causes the uppermost portion of the back
of the heel bone to rub against the tendon. Eventually, due to this constant irritation, a
bony protrusion develops and the bursa becomes inflamed. It is the inflamed bursa that
produces the redness and swelling associated with Haglund’s deformity.
A tight Achilles tendon can also play a role in Haglund’s deformity, causing pain by
compressing the tender and inflamed bursa. In contrast, a tendon that is more flexible
results in less pressure against the painful bursa.
Another possible contributor to Haglund’s deformity is a tendency to walk on the outside
of the heel. This tendency, which produces wear on the outer edge of the sole of the
shoe, causes 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.
Radiographs, ultrasound and MRI along with a physical signs and symptoms are utilized to diagnose the condition.
Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of
the bursa. While these approaches can resolve the bursitis, they will not shrink the bony
protrusion. Non-surgical treatment can include medication, icing, stretching, lifts,
orthosis, physical therapy and extra corporeal shockwave treatment.
If non-surgical treatment fails to provide adequate pain relief, surgery may be needed.
A variety of surgical techniques can be utilized to restore function