What Is Haglund's Deformity?

Haglund's deformity is a bony bump where your Achilles tendon attaches at the back of your heel bone. Because of its prominence, the bump is subject to the effects of constant friction. This causes redness and irritation, and can cause skin thickening, pain, swelling, and increased skin lines.

Haglund's deformity usually develops due to shoes rubbing up against the heel. Abnormalities in foot function, position, or a genetic predisposition may also contribute to the condition.

What Are the Symptoms of Haglund's Deformity

Haglund's deformity usually appears on both feet, rather than just one. The primary symptoms are:

• A noticeable bump on the back of the heel
• Pain
• Swelling
• Redness
• Blisters and/or callouses on and around the bump due to increased friction from shoes
  

Complications

When the bony lump of Haglund's deformity rubs against shoes, it can cause other nearby tissues to become inflamed.

That can lead to complications, including:

• Bursitis: Inflammation of the bursa, a fluid-filled sac that cushions a tendon against bone, can cause swelling and tenderness.
• Achilles tendonitis: Symptoms of Achilles tendonitis such as pain and swelling can occur a few centimeters above the area where the tendon attaches to the back of the heel.

Over time, chronic injury to the Achilles tendon can cause it to weaken and break down, a condition known as tendinosis.

What Causes Haglund's Deformity?

Haglund's deformity is relatively common but not very well understood. It's most common in middle age and affects women more often than men.

Along with genetics and a potentially misshapen bone, issues that can contribute to Haglund's deformity include:

• High arches
• A tight Achilles tendon
• Walking on the outside of your feet
• In runners, over-training
• Tight or poor-fitting shoes
• Abnormal foot biomechanics due to joint misalignment

Footwear can influence whether you develop Haglund's deformity, too. Those most often linked to this problem have a stiff back and include:

• Ice skates
• Dress shoes
• Pumps
• Work boots

How Is Haglund's Deformity Diagnosed?

You may start by seeing your primary healthcare provider, who might refer you to a foot specialist known as a podiatrist.

Haglund's deformity can be diagnosed based on a physical examination and X-rays. Sometimes a magnetic resonance imaging (MRI) scan may be ordered as well.

This condition is sometimes mistaken for other causes of pain in the rear of the foot, so your healthcare provider will use the information they gather to rule out:

• Achilles tendon calcific enthesopathy
• Retrocalcaneal bursitis
• Plantar fasciitis
• Seronegative spondyloarthropathies

How Is Haglund's Deformity Treated?

An array of conservative treatments are aimed at reducing pressure, pain, and inflammation. They don't shrink the bony protrusion itself, but that's typically not necessary. The earlier Haglund's deformity is caught, the better the chance of these being enough to restore function and get rid of pain.

Surgery is not common, but may be considered if other options fail and your condition is significantly affecting your daily life.

Conservative Treatments

Reducing pressure and friction at the site of a pump bump is essential to addressing any inflammation. The best way to do this is to ensure that you are wearing a shoe that fits well and offers adequate support.

Other conservative approaches to treating Haglund's deformity include:

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen)
• Ice to lower inflammation
• Stretching exercises for the Achilles tendon
• Heel pads to reduce irritation
• Heel lifts to decrease pressure on the bone for people with high arches
• Backless or soft-backed shoes
• Custom foot orthotics that improve biomechanics
• Night splints
• Immobilization, such as with a cast or soft boot to allow it to heal
• Physical therapy
• Modalities like ultrasound to lower inflammation

Surgery

If these approaches don't adequately alleviate your pain, you may need to have surgery. Surgery to treat Haglund's deformity is typically done as an outpatient procedure, meaning you will be able to go home on the same day of surgery.

Surgery may include removal of the bony bump. This usually provides pain relief and a return back to a normal lifestyle with no restrictions after a period of recovery.

Sometimes removal or repair of a portion of the Achilles tendon is also done, which requires a longer recovery period.

You will first be given general anesthesia or a nerve block at the knee to make the leg numb. Then, an incision will be made at the heel next to the Achilles tendon so the surgeon can perform the procedure.

Is Haglund's Deformity Surgery Risky?

This type of surgery is generally considered safe and has a high success rate. It isn't without possible complications, however.

Complications associated with Haglund's deformity surgery include:

• Pain
• Weakness
• Tightness
• Rupture of the repair

Rehab and Recovery Post-Surgery

If only the bony deformity is removed, you should expect to have a non-weight bearing cast on, meaning you can't walk, for about two weeks. After that, you'll likely have a walking cast or boot and start physical therapy.

If the Achilles tendon requires any form of repair, weight bearing may be delayed and you will need to wear a special boot with a heel lift. Physical therapy may start two weeks after surgery.

Depending on the type of procedure that was performed, you may be able to resume normal activities and sports six to 36 weeks after surgery.