Author: Chloe Wilson - BSc(Hons) Physiotherapy
Haglunds Deformity is an enlargement of part of the bone on the back of the heel which irritates the soft tissues around the Achilles tendon and causes heel pain. It is also known as Pump Bump or Mulhulland Deformity.
It is commonly associated with other conditions such as bursitis and achilles tendonitis as it causes friction on the surrounding soft tissues.
You may be genetically disposed to Haglunds Deformity by your foot shape, or it can be caused by muscle tightness or friction from shoes.
Here, we will look at the causes, symptoms, associated problems and treatment options for these uncomfortable heel bone spurs.
With Haglunds Deformity, friction over the back of the heel causes the formation of bone spurs in the heel as the body lays down extra layers of bone to try and protect itself.
The Achilles tendon runs down the back of the calf and attaches to the back of the heel bone, the calcaneus. A bursa, a small fluid filled sac, sits in between the tendon and the heel bone to help prevent friction and allow the tendon to move smoothly.
The bony prominence associated with Haglunds Deformity places excessive pressure on the bursa and it becomes inflamed, known as bursitis. This can be extremely painful.
The most common cause of Haglund's Deformity is footwear. Shoes with rigid backs, like pumps, ice skates and high heels place excessive pressure on the back of the heel, hence the alternative name for this condition, pump bump. This can result in the formation of heel bone spurs, forming the characteristic lump.
Other causes of Haglunds Deformity include:
1) Genetics: People with high foot arches are more prone to this condition as it causes the calcaneus to tip backwards increasing the pressure around the Achilles region
2) Muscle Tightness: Tightness in the calf muscle places more tension on the Achilles tendon which increases the pressure on the bursa
3) Walking Pattern: People who tend to walk on the outside of their feet are more likely to suffer from Pump Bump as it subtly changes the position of the heel bone increasing the friction under the Achilles tendon.
The most common symptoms of Haglunds Deformity are:
1) Hard Lump: found on the back of the heel, this develops gradually over time
2) Swelling: there is often noticeable swelling around the back of the heel
3) Redness: The back of the heel may look slightly red due to the inflammation of the bursa
4) Pain: pain is usually felt at the back of the heel around the Achilles tendon. It tends to be quite localised
Treatment initially aims to reduce the inflammation in the bursa and will depend on what caused the condition to develop in the first place:
1) Footwear: Wearing backless, soft-backed shoes or going barefoot helps reduce the friction around the area and is one of the best ways to treat of prevent Pump Bump
2) Heel Pads: You can place soft pads on the
back lip of your shoe to cushion the heel, or underneath the heel to
lift it up and reduce the pressure when walking
3) Stretches: Calf stretches helps reduce the tightness and tension in the Achilles tendon and are a great way to treat and prevent this condition. You can suitable exercises in the calf stretches section
5) Medication: NSAIDs (non-steroidal anti-inflammatory drugs) can be used to reduce the pain and inflammation associated with Haglund's Deformity. Some people prefer to use the cream form and rub it into the back of the heel instead of taking pills. Always check with your doctor before taking any medications
6) Physical Therapy: Treatment such as ultrasound can help to reduce the inflammation associated with bursitis
7) Changing Activities: Avoiding running on hard surface and keeping on the flat rather than going uphill can help prevent Haglund's Deformit
Often, these treatments are enough to cure the pain and inflammation associated with pump bump, although there may still be a lump on the back of the heel.
If symptoms persist, surgery may be required. Most commonly, as small incision is made and the surgeon removes the heel bone spurs, leaving a nice, flat surface. Sometimes, they may also have to remove the bursa and part of the Achilles tendon. You may need to use crutches for a few days following surgery.
If you are getting pain around the back of the heel, but it is not sounding quite like Haglunds Deformity, it may be that you have a problem in the Achilles tendon – visit the Achilles Tendonitis section to find out about the common causes, symptoms and treatment options for this common cause of heel pain.
Alternatively, visit the heel pain diagnosis section for help working out what is causing your pain.