Haglund’s deformity, also known as retrocalcaneal exostosis or a “pump bump”, is a very common condition of the heel. The deformity is caused by an abnormality of the heel bone, or calcaneus, and soft tissues of the foot. The calcaneus tends to enlarge on the back of the bone causing irritation to the soft tissues near, such as the Achilles tendon. Shoes often contribute to the pain and irritation if rub begins due to the enlargement of the bone on the back of the heel. The use of high heel shoes coined the term “pump bump” due to the irritation caused from tight stiff dress shoes and rubbing while walking.
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Symptoms
The most common age for presentation is 40-50 years old, and within females more than males. The symptoms are most commonly bilateral with pain at the back of the heel, more pronounced after rest. Limping and swelling are often seen with time. History of conditions such as gout, rheumatoid arthritis or seronegative spondyloarthropathies should be ruled out as they can mimic the deformity seen. You may have blistering or bursa inflammation on the back of the heel due to the enlarged bump on the back of the heel and shoes rubbing.
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Causes
This condition is caused by genetics, lifestyle and shoes. But, there are factors that contribute to symptoms that present such as tight or poorly fitting shoes, altered biomechanics, and overuse, such as in runners and athletes. A tight Achilles tendon, high arch of the foot, tendency to walk on the outside of the foot, and heredity are also suggested causes of the pain and deformity.
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Treatment
Haglund’s deformities are more often treated conservatively than surgically. X-rays may be taken in order to fully evaluate the heel bone for enlargement Spurs where the Achilles tendon attaches to the heel bone can also be seen on X-rays. Changing the heel height of a shoe, adding orthotics or heel lifts to current footwear, anti-inflammatory medications and physical therapy are most commonly utilized. An evaluation with a Chiropodist or Pedorthist can be performed in order to evaluate shoes, gait and Achilles tendon and ankle flexibility. With acute severe pain, immobilization may be necessary with a pneumatic walker or cast, in a non-weight bearing position.
