If you have a bony enlargement on the back portion of your heel and you’re wondering what it is, there’s a good chance you have a condition known as Haglund’s deformity. Also known as a “pump bump,” this can sometimes be more than just an unsightly annoyance. In some cases, the bone can rub against shoes and irritate the Achilles tendon. This, in turn, can inflame the bursa sac located between the bone and tendon, leading to an extremely painful bout of bursitis.
Here’s some information on why Haglund’s deformity occurs, symptoms of the problem and potential treatment options. You’ll also see some of the steps you can take to possibly prevent this issue from happening.
What Causes Haglund’s Deformity?
While it is not completely clear as to what causes Haglund’s deformity, research indicates that heredity is largely to blame.1 People born with high arches, or those who tend to walk on the outside portion of their heels, may be at a higher risk. If you were born with a tight Achilles tendon, you may be prone to developing the condition as well.
One contributing factor to Haglund’s deformity that has been well established, however, is wearing dress shoes with rigid backs. They can put a great deal of pressure on the enlarged bone, and this pressure only gets worse when walking. The pressure can then ultimately lead to painful irritation.
Haglund’s deformity can lead to a somewhat vicious cycle of irritation and pain.2 The more you wear these types of shoes, the more irritation they can cause this area of the foot. The more irritation that occurs, the greater the chances of inflammation of the bursa sac – and the higher the risk you will develop bursitis. The longer you wear stiff-backed shoes, the larger the bump can get. This can also lead to increased pain.
The most obvious symptom is a large bump on the back of the heel, of course. But you may also notice redness or swelling in the affected area, as well as pain where the heel meets the Achilles tendon. Some people also develop heel blisters due to their shoes rubbing against the enlarged bone.
When to See a Doctor
You can try to put heel pads in your shoes to try and take some pressure off of the bone, or apply ice to the area when you take your shoes off in order to relieve some of the discomfort. But if those options don’t work, you’ll more than likely need to visit a podiatrist.
The doctor will first perform a thorough examination of your foot, and will possibly order an X-ray to get a detailed picture of how your feet are structured. He or she may also decide to order an ultrasound or an MRI to get an even more detailed look.
The first course of treatment will usually be conservative. Your doctor might prescribe a topical or oral medication in order to help you find some relief from the pain you’re experiencing. He or she may also recommend orthotic supports, such as heel lifts or pads, or arch supports. You might need a custom orthotic that can reposition the way your foot sit in your shoes to relieve pressure from your heel.
If you are experiencing severe inflammation, then the area might need to be immobilized through the use of a walking boot or a soft cast so that healing can take place.
Surgery for Haglund’s Deformity
Unfortunately, there are some instances where surgery might be needed in order to correct an occurrence of Haglund’s deformity. For example, if you are still experiencing pain after trying other treatment options, you might need a surgical procedure. Surgery is sometimes used to reduce the size of the enlarged bone or remove it entirely.
But in some instances, surgery may also be needed to correct any degeneration of the Achilles tendon that may have occurred. This is relatively rare, but may be required if there is a risk of an Achilles rupture.
There are usually two options regarding anesthesia. Your surgeon may recommend a general anesthetic or you might receive a nerve-blocking injection at the knee. The enlarged bone may need to be removed, and if there is a degeneration of the Achilles, then the damaged portion may need to be removed as well. Tendon transfer surgery may be needed if the degenerative portion of the Achilles can’t be repaired.3
You’ll probably be able to return home the same day of the surgery, but you might need to wear a splint for a couple of weeks to take weight off of the area. You should be able to once again put weight on the heel after the sutures are taken out.
If, however, you also had surgery to repair or replace the Achilles tendon, then it will probably be a bit longer until you can put weight on the foot. You might need to wear a boot fitted with a heel lift as well as go through physical therapy.
As with any surgery, there are chances that you might experience complications. One potential complication is a slow healing wound, which could be a sign that an infection has set in. If this is the case, then another surgical procedure may be required.
There are some things you can do, however, to avoid the problem in the first place. For example, try to avoid wearing stiff-backed shoes, especially for long periods of time. Wear shoes with open backs if you can instead, unless you have bunions, some sort of structural issue in your foot, or you have tendinitis.
If you’re a runner, avoid uphill running and try to avoid hard surfaces if possible. Wear padded, fitted socks with non-slip soles and always make sure to stretch your Achilles thoroughly before any workout to help prevent it from tightening.
As long as you are proactive in getting treatment for Haglund’s deformity, you should be able to avoid surgery. The pain should subside over time if you take the right precautions.
1.”Foot Health Facts”. Foothealthfacts.org. N.p., 2017. Web. 31 Mar. 2017.
2.”Haglund’s Deformity”. Healthline. N.p., 2015. Web. 31 Mar. 2017.
3.”Haglund’S Deformity Surgery”. Aofas.org. N.p., 2017. Web. 31 Mar. 2017.