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Medical News Today: How do you treat Haglund's deformity?

Haglund’s deformity is a bony bump that appears on the back of the heel bone. This bump forms where the Achilles tendon attaches to the heel. The condition often needs treatment if it causes pain or walking problems.

Treatments for Haglund’s deformity may initially include shoe modifications and physical therapy. If these do not relieve pain, a doctor may recommend surgery to remove the bony ridge or repair the Achilles tendon.

People also refer to the condition as Haglund’s syndrome or “pump bump.” The term “pump bump” followed doctors observing that women who wore high-heeled pump shoes had the condition.

Experts now know that Haglund’s deformity can happen to anyone, and pumps and other shoes are not necessarily exclusively to blame.

What causes Haglund’s deformity?

Haglund's deformity is a bump that appears on the back of the heel.
Haglund’s deformity is a bump that appears on the back of the heel.

Patrick Haglund first named Haglund’s deformity in 1927. The condition has been described as idiopathic, meaning it has no apparent cause, although doctors have linked it to several factors.

A person’s natural foot structure may sometimes make them more prone to Haglund’s deformity.

Doctors have linked some features to Haglund’s deformity, including:

  • A prominent heel bone that slopes outward, making the heel more likely to rub on the backs of shoes.
  • Feet that roll outward when walking, known as supination.
  • Tight Achilles tendons, which may put pressure on the heel bone.
  • High arches, which can force the heel slightly backward during walking and rub the Achilles tendon.

Wearing certain types of shoes may cause Haglund’s deformity, or some shoes may aggravate the condition and bring on symptoms such as pain.

Shoes or boots with rigid backs can cause friction that aggravates a foot structure that is prone to Haglund’s deformity.

People with the foot types listed above may wish to avoid shoes with rigid backs and ensure their footwear fits properly.

The shoes most often linked to Haglund’s deformity symptoms include:

  • ice skates and roller skates
  • dress shoes, including men’s dress shoes, women’s dress shoes, and high-heeled pumps
  • steel-toed work boots
  • stiff winter boots or rain boots

What are the symptoms?

Person with heel pain.
Haglund’s deformity can cause heel pain.

Haglund’s deformity can cause symptoms that range from mild to severe and may include:

  • pain in the back of the heel when walking
  • a visible bump on the back of the heel
  • swelling or redness on the heel
  • calluses or blisters on the heel where the bump rubs against shoes

A doctor may be able to identify Haglund’s deformity by looking at the heel and discussing the symptoms.

Diagnostic tests, such as an X-ray or MRI, may be used to evaluate the shape of the heel bone and to determine the severity of the condition. An X-ray or other tests can help a doctor decide which treatment options may be best.

Haglund’s deformity treatments

Doctors will often try non-surgical treatments for Haglund’s deformity first.

Although none of these treatments can alter the bone or the foot structure, they may provide pain relief for some people and may improve quality of life.

Some non-surgical treatment choices include:

  • Changing the type of shoes worn, especially avoiding rigid-backed shoes and pumps.
  • Placing heel lifts in shoes to help bring the heel up and avoid friction.
  • Using heel pads inside the backs of shoes to help reduce irritation and friction on the heel.
  • Inserting footwear arch supports for people with high arches.
  • Taking anti-inflammatory drugs, such as ibuprofen, to ease pain from an inflamed bursa or Achilles tendon.
  • Using ice on the heel to help relieve inflammation and pain.
  • Doing stretching exercises to alleviate a tight Achilles tendon.
  • Avoiding exercises that aggravate the condition, especially running and running uphill.
  • Using a soft cast or walking boot to help keep the heel bone from rubbing on the bursa or Achilles tendon.
  • Trying physical therapy to bring relief.

Surgery may be needed when non-surgical treatments do not relieve symptoms. Surgery aims to remove the part of the heel bone that is sticking out. Surgery may also be used to repair the Achilles tendon if it is damaged.

Podiatrists and foot and ankle surgeons can perform different types of surgery to correct Haglund’s deformity. The type of procedure depends on how severe the Haglund’s deformity is, the person’s health history, and their lifestyle.

Endoscopic surgery is less invasive than traditional surgery. Because it uses smaller incisions than traditional surgery, the recovery is often shorter. According to 2018 research, it results in good to excellent outcomes in the short and medium-term.

Conventional surgery, however, also appears to have successful outcomes. One study found that the majority of those who had traditional surgery had relief of their pain at their one-year follow-up. But, the authors noted that doctors should tell people that the recovery from surgery can be several months.

How can it be prevented?

Men's open heel and toe sandals or soft shoes on grass.
Wearing supportive shoes with open backs may help to prevent Haglund’s deformity.

People cannot avoid Haglund’s deformity in every case. People may, however, be able to reduce the risk of it developing by taking the following steps:

  • Wearing shoes that have open backs. The American Podiatric Medical Association caution against open-backed shoes if a person has tendinitis, bunions, or other foot problems.
  • Wearing shoes with soft, flexible backs to prevent pressure on the heel.
  • Stretching correctly before and after exercise, especially the calves, Achilles tendon, and feet.
  • Wearing shoes that have proper arch support for people with high arches.
  • Taking a gradual approach to strenuous exercises, such as running, to avoid overuse injuries.
  • Seeing a medical professional right away for heel pain. Haglund’s deformity may get worse over time if it is left untreated.

Takeaway

Haglund’s deformity may be a result of genetic foot structure that people cannot prevent in many cases. Wearing proper footwear and avoiding friction on the heel, however, is a good strategy for preventing this condition.

People who have relatives with Haglund’s deformity may wish to be cautious about footwear choices, avoiding the types of shoes and boots that cause friction on the heel.

Some treatments, fortunately, provide effective relief for Haglund’s deformity. Noninvasive therapies often help relieve pain and may be enough for mild cases. For others, surgery can correct the underlying issue and bring relief.

People should not ignore foot pain. Finding a qualified health professional who treats this condition is key to resuming regular activity as quickly as possible.

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