If you’ve noticed a bump at the back of your heel, then you may have a bony enlargement called a Haglund’s Deformity. As we’ve been seeing quite a few patients with these ‘bumps’ who have recently started developing painful symptoms at the back of their heels, we thought we’d fill you in on what’s going on the what’s, how’s and why’s of this condition. As patients come that come in with heel pain often assume it’s related to their Achilles Tendon, this is a condition that is NOT directly associated with the achilles, though can produce achilles pain as a result.

So, what is a Haglund’s deformity?

As we mentioned earlier, a Haglund’s deformity describes a bony enlargement of the calcaneus (heel bone). You may hear it being referred to as a pump bump because of the firm backs of pump-style shoes that will often rub against it at the back of the heel.

What are the signs and symptoms?

Generally, you’ll notice a palpable lump at the back of your heel that has been irritated. This irritation can cause pain and tenderness in the area, along with redness and swelling. The swelling can there irritate the surrounding structures and lead to things like bursitis, or even pain at the achilles tendon.

What causes the painful symptoms?

While many people with an enlargement at the back of the heel can go through their lives without developing pain, symptoms can develop from irritation and rubbing of tissues against the bump, for which there may be various causes. Note: it isn’t actually the presence of the bump itself, but the resulting friction with other tissues. Causes of the irritation can include:

• Injury to the heel
• Footwear that is tight or has a firm heel counter
• Tight calf muscles or achilles tendon
• Structural foot abnormalities such as a high arched foot
• Abnormal foot biomechanics such as rolling inward or outward excessively
• Gait abnormalities, such as walking on the outside of the heels

What should you do if you suspect you have a Haglund’s deformity?

If you haven’t experienced any pain or symptoms and just have the bump present at the back of your heel, then you may not require any treatment as the presence of the bony enlargement alone does not mean that anything is ‘wrong’ or that you’re definitely going to develop painful symptoms. It can, however, make you more like to develop symptoms. In this case, it’s all about making small changes to minimise your risk of this occurring. This can include:

• Avoiding tight footwear
• Avoiding footwear that has a firm heel counter over the area of your ‘bump’
• Regularly stretching the calves and achilles tendon to reduce the likelihood of rubbing
• Managing abnormal gait and foot abnormalities through devices such as orthotics

Where painful symptoms have manifested, treatment looks to reduce the painful symptoms and then alleviate the tension from the back of the heel. Your podiatrist will create the best treatment plan for you based on your symptoms and presentation. This may include:

• Resting and icing the heel
• Using anti-inflammatories to reduce painful symptoms
• Heel lifts to reduce the strain at the back of the heel
• Avoiding footwear that is tight and rubs against the back of the heel
• Using orthotics to reduce tension from the back of the heel
• Physical therapy to stretch tight muscles such as the calves and the achilles tendon

It’s important to have your feet and legs assessed to gain an understanding all of the biomechanical and structural factors that are contributing to your painful symptoms and therefore create the most effective treatment plan for you. Our team here at Perform Podiatry are experts in sports medicine and the biomechanics of the feet and legs, and have the pleasure of helping thousands of Aucklanders each year. For more information or to make an appointment, give us a call on 09 523 2333 or book online.