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What Is A Haglund's Deformity?
Symptoms
Causes
Risk Factors
Diagnosis
Treatment
FAQS

A Haglund’s deformity is a common cause of heel pain at the back of the heel, and may often be mistaken for Achilles tendonitis pain.

What Is A Haglund's Deformity Or "Pump Bump"?

A Haglund’s deformity is a bony enlargement that presents as a noticeable bump right at the back of the heel bone (calcaneus). These bumps can vary in size, and are both palpable and noticeable when looking. While the term ‘Haglund’s deformity’ was given because the condition was first discovered by Patrick Haglund, the term pump bump was coined because of the pump-style shoes with firm straps that tend to rub against the back of the heel, and contribute to painful symptoms.

Symptoms: How To Know If You Have A Haglund's Deformity

Interestingly, the bony enlargement itself is actually asymptomatic and painless. When symptoms present, it is actually coming from the surrounding structures, such as the Achilles tendon or the bursa at the back of the heel, which can become irritated from the way the presence of the bump causes them to be used, or from shoe straps rubbing against them. As such, you may experience:

• Pain at the back of the heel
  
• Inflammation
  
• Redness and warmth over the bony bump
  
• Callus may form over the bony bump with repeated rubbing and friction
  
• Pain from exercise, particularly where the Achilles tendon is engaged
  
• Pain when walking after rest
  
• Limping during walking
  

What Causes A Haglund's Deformity?

Through the research, Haglund’s deformities remain fairly poorly understood, without a clear cause or understanding as to why the particular bony section of the back of the heel where the Achilles tendon inserts becomes enlarged. While it is often considered idiopathic (meaning that it can occur spontaneously), what is known is that the bump can cause the surrounding tissues to become irritated from rubbing against footwear, which is why we can suddenly develop symptoms when switching to a new pair of shoes. It is thought that this repetitive rubbing at the back of the heel may also play a big role.

Several factors contribute to the development of Haglund's Deformity, and a combination of these factors may increase the risk of its occurrence:

• Those with high arches or a tight Achilles tendon can experience increased pressure on the back of the heel, leading to the formation of a Haglund’s deformity
  
• If there is a family history of this condition, individuals may have an increased likelihood of experiencing a similar foot structure and biomechanics.
  
• Wearing shoes that are too tight, have rigid backs or those with a firm, high heel counter can contribute to the irritation of the Achilles tendon and the formation of a bony prominence. The constant friction and pressure on the back of the heel can exacerbate the condition.
  
• Abnormalities in foot mechanics, such as excessively rolling the foot inward or outwards, can contribute to the development of Haglund's Deformity as these biomechanical issues alter the distribution of forces on the foot.
  
• Activities that involve repetitive friction and pressure on the back of the heel, such as running or wearing ill-fitting shoes, can also contribute to the formation of a bony bump.
  

Risk Factors

Several risk factors have been suggested to play a role in the development of a pump bump, including:

• Over-practice in runners, which means that the Achilles tendon is repetitively rubbing against the back of the heel
  
• Tight or poorly fitting shoes, which rub against the back of the heel
  
• Altered biomechanics of foot joints because of the improper alignment of a joint close to the ankle called the subtalar joint 
  

Diagnosis

A Haglund’s deformity can be confidently diagnosed by our podiatrists from a clinical examination, and your history. Medical imaging may be used to provide further clues about the cause of the pain - whether that is from an inflamed bursa, damage to the Achilles tendon at its insertion, or something else. Your podiatrist will thoroughly examine your heels, going beyond noting the presence of the deformity to uncovering what is causing your painful symptoms, to best guide your treatment and recovery.

Differentiating Haglund's Deformity from Other Heel Conditions

Part of an effective management plan means ruling out other conditions that share similar symptoms and presentations as a Haglund’s deformity. In this case, your podiatrist will rule out conditions including Achilles tendonitis, retrocalcaneal bursitis, insertional Achilles tendinopathy, a calcaneal stress fracture, and Sever's Disease in children, among other conditions.

Treatment For A Haglund's Deformity

 Treating a Haglund’s deformity means treating the damaged tissues at the back of the heel in order to relieve symptoms, and then preventing them from recurring. Your podiatrist will discuss the best treatment options for you following your assessment, which may involve:

• Using ice and anti-inflammatories to help relieve your painful symptoms at home
  
• Using temporary heel lifts to reduce the strain on the tissues at the back of your heel, thereby reducing pain
  
• Avoiding footwear that is tight and rubs against the back of the heel, helping to prevent your symptoms from worsening
  
• Making shoe modifications to your existing footwear, a unique treatment option that our Brisbane and Newmarket clinics can offer directly
  
• Using custom foot orthotics to help permanently reduce excess tension on the back of the heel by addressing identified biomechanical factors, and potentially having a slight in-built heel raise if indicated
  
• Using the MLS laser as a proven, painless and safe way to help manage the pain at the back of your heel while reducing any inflammation.
  
• An exercise program to stretch tight muscles like the Achilles tendon
  

Once the pain has gone, your podiatrist will then work with you to help set you up for success in the future and prevent your symptoms from returning. This includes educating you on the how’s, what’s and why’s of having a pump bump, so you know exactly what you should be doing and avoiding, including the best shoes for your feet. As experts in foot health, working with a podiatrist means that you stay supported every step along the way, to help you get the best outcomes for your foot health.

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