Haglund's deformity is a condition affecting the foot. It also is known as 'pump bump' because rigid pump footwear is often the culprit. Women are much more prone to the condition than men due to their choice of footwear. Another name for the condition is retrocalcaneal bursitis. The combination of tendonitis of the Achilles' tendon and bursitis of the underlying bursa combine to define Haglund's deformity.
The largest bone in the human foot is the heelbone (calcaneus). This is the bone to which is anchored the Achilles' tendon. Between the calcaneus and the tendon lie bursa, which are lubricated sacs which allow for free movement of tendon against bone or other tissue.
The problem arises due to the structure of the calcaneus. As with other physical features, not all heelbones are created the same. Some possess a more prominent bump below the tendon attachment point than others. Those with larger projections are more prone to experience pressure between the bump and their footwear. This pressure creates inflammation and pain as well as a thickening of the tissues affected, which serves to further exacerbate the condition.
The symptoms of Haglund's deformity are inflammation, swelling of the underlying tissue where the shoe creates pressure, and development of a callus which may become quite thick. The bursa become swollen and inflamed as well, creating bursitis. The Achilles' tendon becomes inflamed with tendonitis. The condition is not debilitating as far as function of the foot except for the pain experienced during walking.
Diagnosis of the condition is usually quite simple, the prominent bump of the heelbone exhibiting the cause. X-ray of the site further defines the condition and helps eliminate other conditions which could cause similar symptoms.
Treatment falls under two types, surgical and non-surgical. Non-surgical treatment includes elimination of the pressure by footwear. Changing to shoes which do not put pressure on the calcaneus will usually decrease tenderness and swelling, returning the foot to almost previous condition. Sometimes padding is used to cushion the affected area, thereby removing pressure. Ice may be used to reduce swelling. Anti-inflammatory medication may be helpful in reducing swelling and tenderness. Various types of shoe modification may be utilized. Heel lifts help those with high arches. Other orthotic devices may be helpful in that they can control the way pressure is applied to the foot during walking. Those with very tight Achilles' tendons may benefit from exercises which increase flexibility. Tight tendons increase the pressure upon the bursa between the tendon and bone, therefore stretching exercises will sometimes alleviate excessive pressure.
Surgical treatment may include removing a portion of the calcaneus or reshaping it. A small incision is made on the heel and appropriate removal/shaping is performed.
Another technique used is to actually shorten the calcaneus by removing a section or wedge from it. This is known as a wedge osteotomy. After surgery the site is closed with stitches and the foot may be immobilized with a cast or bandages. Stitches may be removed in from 10-14 days. Restricted use should be exercised for up to 6 weeks to allow healing and give the tissues time to reduce swelling and inflammation. Often physical therapies such as soft tissue massage and untrasound are used to aid in pain and speed return to functionality.