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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.

Sources:

http://www.orthogate.org/patient-education/foot/haglunds-deformity-of-the-foot.html
http://www.footphysicians.com/footankleinfo/haglunds-deformity.htm

As kanoodle mentions Haglund's deformity is a condition affecting the calcaneus or heel bone. Abnormal deposits cause it to protrude, irritating the surrounding tissues and frequently causing pain. There are several factors that may come into play when Haglund's deformity develops. Having a tight or short Achilles' tendon can compress the bursa found between your heel bone and your tendon. Having a high arch can force your calcaneus rearward causing incresased internal pressure and subsequent callus formation. While pumps are implicated be wary of: footwear with an overly stiff heel counter, poorly fitting shoes, work boots and athletic shoes with insufficient padding that may deprive your heel of protective cushioning and adequate room needed for your foot to move inside of your shoe.

Anyone suffering from the heel pain associated with Haglund's deformity can tell you that in addition to discomfort finding footwear is going to be problematic. Haglund's deformity causes a specific type of footwear related complication. The abnormal growth sticks out behind the heel, it must be avoided and/or accomodated if the individual is going to be comfortable and it can cause people who are trying to deal with this to buy shoes that are longer than their foot needs. Imagine taping a marble to the back of your heel and trying to fit that into a shoe. While a small amount of heel movement is desirable inside of a properly fitted shoe people with Haglund's deformity frequently find their heel wedged into shoes or they allow an excess amount of movement to occur which creates other problems for them.

Having a small bump on your heel may not seem like a big deal since it rarely interferes with foot function however this is a potentially serious problem that can interfere with your ability to walk without pain. Conservative treatments for Haglund's deformity include stretching the Achilles' tendon and I would include the plantar fascia which is the name for the tendon once it starts running beneath your foot. Good footwear is a must for anyone seeking to relieve the pain that can aggravate their every step. Even if the deformity is not painful it should be noted and accomodated since it is damage and may lead to future foot related injuries. Once you have the growth and conservative treatments such as rest, ice, stretching and anti-inflammatory medications have failed you may be a candidate for surgical correction.

This is not a particularly difficult surgery however anything that involves humans carries a degree of potential error and sometimes total correction is not possible. The two methods traditionally used include shaving down the heel bone or shortening the calcaneus by removing a wedge shaped piece. Sometimes surgeons will opt for keeping the calcaneal tendon attached even though that can be less effective than removal since there are more complications associated with tendon surgery. Athletes whose performance depends on having mobile joints and tendons may decide to play through the pain which is not a good idea. Similarly some people ignore the irritation before it becomes full blown pain which is also not smart. Bony growths are typically the result of your body trying to protect itself. If a particular area is under stress your body will rush additional blood and nutrients to the injured site and if the injury to the tissues persists the growth will keep pace with the demands your body is making.

Once acquired Haglund's deformity is an annoying, irritating, possibly expensive and painful condition that is not easy to get rid of. If you have rear heel pain determining the cause is going to help guide you towards a treatment plan. Healthy bones, joints, nerves, tendons and ligaments are in your best interest which is why stretching and lengthening measures should be practiced even by those whose heel bones are normal. Activity is good as it stimulates blood flow and circulation however over doing things is just as bad as under doing them. Find shoes that fit and be conscious of any foot pain, irritation or annoyance you notice as you move through the day. Some shoes with soft backs or clogs without backs may help prevent further discomfort. As kanoodle mentions there are also heel pads, lifts, certain shoe modifications and orthotics that may be used independently or collectively to alleviate your pain.

To summarize: certain people are more likely to develop Haglund's deformity than others. Educate yourself as to the foot and arch type you have. Listen to your body and remember that vanity and ignorance frequently contribute to minor problems that blossom into major ones. If your New Year's Resolution included stepping up your activity level remember that pain is different than soreness which should subside within a few days. Take care of your feet while they are flexible and strong because as many people can tell you, Haglund's deformity is a good way to discover that you didn't know what you had in terms of range of motion and pain free movement until it is gone.

Sources:

Basic overview

Patient complaints and discussions

Surgical reduction video

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