HAGLUND'S DEFORMITY
Mechanical impingement at the heel: Haglund's deformity explained
Haglund's deformity – also known as a "pump bump" or a posterior heel spur – is a mechanically caused bony prominence at the back of the heel bone (calcaneus), directly above where the Achilles tendon attaches. This bony outgrowth can lead to chronic irritation of the surrounding soft tissue, particularly of the Achilles tendon and of the bursa (bursa retrocalcanea). The condition frequently occurs in people who are active in sport, but it can also be brought on by unfavourable biomechanics or unsuitable footwear.
At its core it is a mechanical conflict: friction and pressure at the back of the heel bone lead to painful inflammatory reactions and to increasing loss of function.
How does Haglund's deformity develop?
Haglund's deformity is a mechanically caused, structural overload syndrome at the back of the heel. It arises from the interplay of a bony variation in the shape of the heel bone (a prominent posterosuperior calcaneal process), chronic pressure from footwear and increased tension on the attachment of the Achilles tendon. In the course of this biomechanical conflict a reactive bony outgrowth forms, which in turn provokes inflammatory irritation of the retrocalcaneal bursa and of the adjacent tendon and soft-tissue structures – with increasing loss of function and persistent pain around the attachment of the Achilles tendon.
- Anatomical predisposition: a high attachment on the heel bone (a prominent posterosuperior calcaneal process) favours the formation of an exostosis.
- Mechanical overloading: excessive tensile load on the Achilles tendon (through sports with frequent sprinting, jumping or changes of direction, for example) irritates the attachment of the tendon.
- Pressure from footwear: tight or stiff heel counters press against the heel region
- Accompanying soft-tissue irritation: chronic pressure leads to inflammation and thickening of the bursa (bursitis retrocalcanea) and to irritation of the Achilles tendon (Achilles tendinopathy).
- Altered biomechanics: deformities of the foot such as a pes cavus (a high-arched foot) or a more upright heel position in the gait increase the load on the affected area.
Symptoms
The symptoms of Haglund's deformity arise above all from the mechanical friction between the bony prominence at the back of the heel bone and the soft tissue lying over it – particularly the bursa (bursa retrocalcanea) and the Achilles tendon. The symptoms often develop gradually and get worse with sustained loading or unsuitable footwear.
Pain
Localised pain at the back of the heel: usually the area above the attachment of the Achilles tendon is affected, where the pressure from the exostosis is greatest.
Swelling
Inflammatory reactions around the bursa (bursitis) lead to a palpable, sometimes reddened swelling behind the heel bone.
A feeling of friction
Many people describe a feeling of tightness or pressure around the heel, as though "something were rubbing in the shoe".
Treating Haglund's deformity
Treatment of Haglund's deformity aims to remove the mechanical irritation at the back of the heel, or to reduce it considerably. The choice of treatment depends on the severity of the symptoms, on how pronounced the bony prominence is and on how well it responds to non-surgical measures. In many cases targeted non-surgical treatment already brings a marked relief of symptoms. Where this is not sufficient, or where there is structural damage (involvement of the Achilles tendon, for example), surgery becomes necessary.
Treatment options
Non-surgical and surgical – we will find the right approach for you
Adapting footwear
Avoiding tight or hard heel counters. Instead: soft, well-padded footwear with as low a heel edge as possible.
Heel cushions or wedges
Raising the heel by a few millimetres in order to reduce the tension on the Achilles tendon and minimise friction against the exostosis.
Physiotherapy
Targeted stretching for the calf muscles and the plantar fascia, mobilisation of the surrounding soft tissue and improvement of the way the foot rolls through the gait.
Anti-inflammatory treatment
Cooling, lymphatic drainage and non-steroidal anti-inflammatory drugs (ibuprofen, for example) to relieve pain and reduce swelling.
Removing the bony exostosis (calcaneoplasty)
The prominent bony bump is smoothed or removed in order to end the friction against the footwear and the soft tissue.
Removing the bursa (bursectomy)
With chronic bursitis the inflamed bursa is removed completely.
Debridement of the Achilles tendon
Where there is tendinopathy or a partial tear at the same time, the Achilles tendon can be cleaned up and stabilised (with sutures or partial reattachment, for example).
Frequently asked questions about Haglund's deformity
What exactly is Haglund's deformity?
Why is Haglund's deformity also called a "pump bump"?
What causes Haglund's deformity?
What symptoms does the condition cause?
How is the diagnosis made?
Can the symptoms resolve without an operation?
When is an operation worthwhile?
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