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Haglund’s Deformity

Symptoms

If your heels are sore, you may be suffering from Haglund’s Deformity, a common problem that a foot doctor can treat. A deformity is an irregular formation. In this case, the irregularity occurs in the heel bone. The doctor can determine what’s wrong by evaluating your symptoms, looking at your feet and even taking x-rays, pictures of the interior of the foot.

Haglund’s Deformity can exist without pain. If irritated, it can take many forms but generally, symptoms include:

  • A large bump on the back of the heel
  • Pain where the Achilles tendon connects with the heel
  • Swelling in the heel area
  • Heel redness

The condition is common in women who wear high heels or pumps and is often called “the pump bump.” The rigid back of a high heeled shoe aggravates the bump when walking. Other shoes, such as ice skates, men’s dress shoes or any shoes with a rigid back can have the same effect. The condition is more common in individuals with high arched feet, also known as cavus feet, because as the heel bone tilts up, it creates pressure.

Runners are often affected by Haglund’s Deformity as are women in their 20s and 30s. Many doctors believe younger women are affected because of their propensity to wear high-heeled shoes.

 

 

What’s that bump on my heel?

The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. The irritation affects the bursa, a fluid-filled sac between the tendon and the bone in the foot. Bursae, only a few cell layers thick, are found in many places in the body where tissues move against each other. They form to allow for the smooth gliding of these tissues. In the foot, they rest between the calcaneus, the largest foot bone known as the heel bone, and the large Achilles tendon attached to the back of the calcaneus. The bursa is positioned here to allow the Achilles tendon to glide over the back part of the heel bone. When they become irritated, they turn thick and painful. This is known as bursitis, or as an inflamed bursa. When this bone becomes enlarged, inflammation occurs and appears as a bump on the heel.

It is the inflamed bursa that produces the redness and swelling associated with Haglund’s Deformity. Sometimes, it is hard to determine whether bursitis is the cause of the heel inflammation or whether it may be a problem involving tendon inflammation or Achilles tendon tears causing pain. If there is neither of these conditions, heel pain is usually related to Haglund’s Deformity.

While the name, “Haglund’s Deformity,” may sound scary, it’s simply a way of paying tribute to Dr. Patrick Haglund, the first doctor to describe a deformity associated with heel pain. In 1928, he saw a 20- year-old patient who he believed had this bone irregularity. He believed more “cultured people,” suffered from this condition because they either wore high heels or stiff shoes while playing golf or hockey.

 

What causes Haglund’s Deformity?

Many factors play a role in the formation of this deformity including:

• Heredity

• An imbalance in the muscles or trauma

• Deformity in the bone

• A tightness in muscles of the back of the leg

• Over-stretching the band of tissue from the ball of the foot to the heel

• Being overweight

• The need for exercise warm-ups and proper training

Some people inherit a foot structure that lends itself to Haglund’s Deformity. High arches can contribute to the irregularity. The Achilles tendon attaches to the back of the heel bone in all feet. In a person with high arches, the heel bone tilts backward into the Achilles tendon. This causes the highest portion of the back of the heel bone to rub against the tendon. Eventually, constant irritation causes a bony protrusion to develop and the bursa becomes inflamed. A tight Achilles tendon can also play a role in Haglund’s Deformity, causing pain by compressing the tender and inflamed bursa. In contrast, a more flexible tendon usually means there will be less pressure against a painful bursa.

Another possible contributor to Haglund’s Deformity is a tendency to walk on the outside of the heel. This tendency produces wear on the outer edge of the sole of the shoe and the heel rotates inward. In this case, the heel bone grinds against the tendon. The tendon protects itself by forming a bursa, which eventually becomes inflamed and tender. People who are overweight will no doubt place more stress on their feet and be more prone to a variety of foot problems. Similarly, runners, particularly those who run long distances, and other athletes may suffer, especially if they fail to warm up or train properly or injure themselves while exercising.

If you have any of these factors, that doesn’t mean there isn’t a remedy for you. Read on!

 

So what can I do?

Mild cases can be treated with ice, compression, exercises, a change of shoes, Achilles Heel pads or orthotics. When the bone is enlarged, surgery may be necessary.

Immobilization or a cast walking boot for severe symptoms can alleviate symptoms as can oral anti-inflammatory medications. You want to try every remedy first before considering surgery because the recovery time is as long as eight weeks.

 

Home remedies will shrink the inflammation but will not eliminate the bony protrusion. However, that may be enough. You can ask your doctor which of these would be best for you:

  • Ice the inflamed area to reduce swelling. Try 20 minutes after you wake up each morning. Put a thin towel on your skin and put the ice over the towel.
  • Use heel lifts placed inside the shoe to decrease heel pressure, cushion the heel and reduce irritation while walking. Custom arch supports can control the motion in the foot that aggravates the condition.
  • Immobilize the foot and ankle in a cast or brace.
  • Wear backless shoes or softbacked shoes to minimize irritation
  • Avoid running uphill
  • Use anti-inflammatory medications to reduce pain and inflammation. Some patients also find topical pain reliever applied directly over the inflammation site beneficial.
  • Exercises can help relieve tension of the Achilles tendon. If you have a tight heel cord, stretching exercises may help you.

 

What if home remedies don’t work?

Alleviating the deformity with cortisone injections has been a controversial option. The injections have lead to the rupture of the Achilles’ Tendon. However, a newer practice of using ultrasound to determine exactly where to complete the injection may result in fewer problems. Whatever you chose to do, early, aggressive treatment of heel bone inflammation can keep you out of surgery.

A foot doctor can perform scans such as a CT, MRI or X-Ray to determine if surgery is needed. Surgery is only considered when all other measures fail to relieve the problem and the pain becomes intolerable.

Most surgeries to relieve Haglund’s Deformity are successful! Surgical procedures reduce the size of the bump so that shoes do not pressure it. Over time, the thickened tissues shrink to near normal size if the pressure is removed. The bump is removed by cutting it off. The Achilles tendon is moved away so that the surgeon can see the back of the calcaneus or heel bone. The remaining bone is rounded to remove pressure. The incision is closed with stitches and covered with a large bandage while it heals. Your leg may be placed in a splint from the knee down. In another surgery called Wedge Osteotomy, the heel bone is shortened to reduce pressure. After surgery, you may require crutches for a few days after surgery. Stitches are generally removed in 10 to 14 days. If the surgeon uses stitches that dissolve, there will be no need to take them out. You should be able to do all your activities in about six to eight weeks.

 

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