Haglundís deformity is a painful bump on the back of the heel. This has been referred to as a "pump bump", as high heel shoes irritate this bump causing much pain. This may also medically be referred to as a retrocalcaneal exostosis. Retro means behind and calcaneal refers to the bone it involves, the calcaneous (heel bone).
Symptoms of Haglundís deformity begin with a noticably enlarged bone prominence on the back of the heel. This may be more on one side or directly in the back. This is more commonly seen at the area where the Achilles tendon attaches to your heel. The bump may be painful especially when tight shoes are worn against the area. It may be red and swollen, or form a bursa which can become inflammed to become a bursitis.
Causes of a Haglundís deformity are usually structural in origin. Foot structure is due to hereditary for the most part, meaning it was the way you were born. Other factors such as increase in weight, injury, improper shoes, or different activities may change the way your foot functions as well. Tight shoes or wearing shoes with a low heel counter will not cause the bump, but may cause symptoms to occur. With constant friction a bursitis may occur.
Diagnosis for a Haglundís deformity is a very common reason for having heel pain in the back of the heel. Heel pain may be due to other types of conditions such as tendonitis, Stress Fracture, Tarsal Tunnel Syndrome, or low back problems. A more common condition in children is Severís Disease. The diagnosis is usually made with a combination of x-ray examination and symptoms.
Prevention of Haglundís deformity may be best by finding a good supportive shoe. Wearing shoes or padding to reduce the friction in the area of the bump may decrease symptoms. Ice may work well at the times of severe pain. For a chronic pain, or longer lasting heat therapy and massage may improve the condition.
Podiatric Care for conservative treatment of a Haglundís deformity is usually aimed at reducing the pressure on the bump that has already formed. Wearing good shoes at this point will probably not get rid of the already formed bone deformity. You probably will be advised on the best shoes to wear or some inserts for your shoes. Your podiatrist may suggest that a custom made orthotic be made to allow your foot to function in the most ideal way especially if you have excessive pronation. Medical treatment may include anti-inflammatory oral medications to decrease swelling and pain. If a bursitis is present the medication may greatly improve the symptoms. Your podiatric physician may also recommend a surgical procedure to actually remove the bump from the back of your heel or to fix the structural problem of your foot.
Surgery to correct for a Haglundís deformity is a procedure commonly done to reduce the pressure of the bone against your shoes. The surgery can be a fairly simple removal using a saw or rasp, or may become more involved if it's involved in the attachment of the Achilles Tendon. If a significant amount of this tendon is reflected to get to the bone, an additional procedure may be performed to anchor the tendon tightly to the bone again.
Post-operative Care and Risks of surgery for reduction of Haglundís deformity depends on the exact surgery done and the amount of Achilles tendon involvement. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and an occasional ice pack placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. Especially if the Achilles tendon is reattached with an anchor your Podiatric Surgeon may ask that you keep all weight off of this foot, typically for 3-6 weeks. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know. Following healing of the surgical site your surgeon may send you to a physical therapist to aid in recovery.