Haglund's Deformity ("Pump Bump")

Description
Have you ever seen a rhinoceros? A photograph will do, although seeing one in person is, of course, a much more visceral experience. Anyway, you have the picture of a rhinoceros in your mind, right? Beady eyes, leathery skin and, most importantly, that enormous horn right at the end of its nose? Great.

Now, imagine that this rhinoceros has somehow gotten inside your foot. (Okay, it's a test of the imagination, but try anyway. It might help if you imagine a very small rhinoceros.) Its round rump is hanging out near your toes, and it's facing the back of your foot, with its horn pushing out at your heel, right about where your Achilles tendon attaches to the calcaneus (your heel bone). Now, imagine what it would feel like to have that rhino horn pushing from inside your heel every time you put on a pair of shoes with a nice, stiff back. Not exactly comfortable, right?

Well, the calcaneus isn't really much like a rhinoceros. It lacks the irritable nature, for one. But it can have a bony enlargement on it (that may or may not be shaped like a rhinoceros horn) that can cause irritation and even significant pain in your heel. This bony bump is called Haglund's deformity. In point of fact, it might spread across the whole back of the heel, or just a portion of it, usually on the outside of the heel.

Now, let's briefly talk about the anatomy of the back of your foot. There's your heel bone (the calcaneus), the Achilles tendon (which attaches to the back of your heel), and a little fluid-filled sac of tissue called a bursa that sits in between the bone and the tendon, allowing the tendon to move smoothly. If you have a bony prominence on your heel bone (remember the rhino horn), you're likely to develop bursitis (inflammation of the bursa) and other irritation to your tissues when you wear shoes with stiff backs, which put pressure on the back of your heel. These dastardly shoes include women's pumps (which is why Haglund's deformity is often called "pump bump"), men's dress shoes, and (sadly) ice skates.

You're more likely to develop this condition if you tend to walk around on the outside of your foot, have unusually high arches, a tight Achilles tendon, or if you have a very small rhinoceros living inside your heel.

Symptoms
The most common symptom of Haglund's deformity is pain at the back of the heel, usually right around where the Achilles tendon inserts into the heel bone. This pain is often accompanied by a noticeable bump on the heel, swelling, and redness. You may develop a callus on the back of your heel as the skin and other tissues harden in an attempt to protect themselves from irritation.

Diagnosis
Many podiatrists are able to diagnose Haglund's deformity by doing a good physical exam of the foot, although you'll probably also be asked to give a history of your symptoms (and other medical history). Your podiatrist will likely order X-rays of your heel as well, to see how your calcaneus is shaped (and to detect any lurking rhinoceroses).

Treatment
Because this condition is greatly worsened by wearing shoes with stiff backs, your podiatrist is likely to recommend a change in shoe wear. Clogs or other shoes with no backs or soft backs will likely provide some relief from irritation.

In addition, your doctor may also recommend some methods of reducing the inflammation in your heel. These may include medication (often non- steroidal anti-inflammatory meds like ibuprofen), ice (20 minutes on over a thin towel, and 40 minutes off), and sometimes immobilization in a cast. Orthotics (prescription shoe inserts) may also provide relief. Heel lifts, heel pads and arch supports are helpful for many patients. Physical therapy (including ultrasound treatments, soft tissue massage and moist heat) and exercises to stretch the Achilles tendon may also help.

If these options don't adequately improve your condition, surgery may be a good option for you. Some surgeries remove the bony prominence from your heel bone, while others remove a wedge of bone from the calcaneus in order to reduce pressure on the back of your heel.

So, you see, whether your problem is caused by a tiny rhinoceros in your heel or a calcaneus that simply thinks it's a rhinoceros, you can, with proper treatment, enjoy a pain-free life.