Haglund’s deformity is a bony enlargement on the back of the heel bone or calcaneus, where the Achilles tendon is attached. When the bony prominence rubs against shoes or boots the area becomes irritated, often leading to bursitis, an inflamed fluid-filled sac between the tendon and the bone.

Causes

Haglund’s deformity is often called “pump bump” because the stiff backs of pump-style high-heeled shoes can create pressure that aggravates the enlargement when walking.  Here in the mountains of Colorado, the more common cause is pressure from ski boots, hiking boots or ice skates.

To some extent, heredity plays a role in Haglund’s deformity. Inherited foot structures that can make one prone to developing this condition include a high-arched foot, a tight Achilles tendon or a tendency to roll the foot to the outside of the heel when walking.

Symptoms

Haglund’s deformity can occur in one or both feet. Symptoms often will include pain and swelling at the back of heel where the Achilles tendon attaches.  Most patients will have a noticeable enlargement at the back of the heel.  Pressure from footwear or activity usually will exacerbate the problem.

Diagnosis

A thorough physical examination and X-rays are usually all that are necessary to diagnose a Haglund’s deformity.  Additional biomechanical examination is performed to determine structural and functional problems with the foot or gait that may be contributing to the condition.

Nonsurgical Treatment

Nonsurgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they do not address the bony protrusion. Nonsurgical treatment may include one or more of the following:

Medication.  Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be recommended to reduce the pain and inflammation.  Prescription NSAIDs or topical anti-inflammatory medications may help as well.

Ice. To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.

Exercises. Stretching of the Achilles tendon will help to reduce tension at its attachment point to the back of the heel bone. These exercises are especially important for the patient who has a tight heel cord.

Heel lifts. Patients with high arches may find that heel lifts will reduce the pressure on the heel.

Heel pads. Pads placed inside the shoe cushion the heel and may help reduce irritation when walking.

Shoe modifications. Open back or soft backed shoes help avoid or minimize irritation.

Physical therapy. Physical therapy modalities, such as ultrasound, can help to reduce inflammation.

MLS Laser Therapy. MLS laser therapy performed at ESFA may help to reduce the pain and inflammation of bursitis associated with Haglund’s deformity.

Orthotic devices. Custom arch supports control the motion in the foot to reduce friction at the back of the heel bone.

Immobilization. In severe cases, use of a walking boot for a period of time may be necessary.

When Is Surgery Needed?

If nonsurgical treatment fails to provide adequate pain relief, surgery may be recommended. Removal of the chronically inflamed bursa and underlying bony prominence provides lasting relief when necessary.