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.

Call 719-543-2476 today to schedule your appointment!