What is Haglund’s deformity?

Haglund’s deformity is a bony bump that forms at the back of the heel where the Achilles tendon meets the bone. The extra bone growth is often associated with heel irritation and other conditions like bursitis or tendonitis as the inflammation becomes more severe. The deformity affects the bone and the surrounding soft tissue. 

Some refer to Haglund’s deformity as a “pump bump” because certain shoes with tight straps across the heel like high heels or pumps cause the bony growth and can worsen its symptoms. While anyone can develop the deformity, the abnormal bone growth is seen most commonly in people who frequently wear shoes that press up against the heel.  

The deformity gets its name from the Swedish podiatrist Partick Haglund, who first described the bone deformity in 1927. Haglund’s deformity is not rare, but it is unknown how many people have the bone growth due to an underdiagnosis of the deformity.

What causes Haglund’s deformity?

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The exact cause of Haglund’s deformity is still being explored in scientific studies. Some studies have indicated the cause might have a genetic connection while others theorize that the bone growth on the heel could be due to constant pressure or irritation on the heel or general overuse of the heel.    

Heredity could play a role in the cause of the deformity because you may be predisposed to Haglund’s deformity if your foot structure involves a chronically tight Achilles tendon, a gait that makes you walk on the outside of the foot, or a high arch. 

In addition to the anatomy of your feet, the shoes you wear can also cause Haglund’s deformity. Shoes that constrict your foot and that create considerable friction on your heel may lead to the bone growth due to inflammation and irritation. Ice and roller skates, dress shoes with a hard back, steel-toed work boots, and still winter boots all tend to cause Haglund’s deformity in people who wear shoes like these with frequency. 

When the body senses stress on the area of the heel where the Achilles tendon meets the heel bone, it reacts by attempting to reinforce the stressed area with new bone. This buildup of new bone over time forms the characteristic bump of Haglund’s deformity. 

What are symptoms of Haglund’s deformity?

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There are a variety of symptoms associated with Haglund’s deformity that will range in severity depending on the person. In most cases of Haglund’s deformity, the bone growth will appear in both feet at the same time. 

Common symptoms of Haglund’s deformity include:

  • Blisters and calluses at the site of the bump
  • A visible bump at the back of the heel that feels bony
  • Pain in the heel 
  • Swelling in the foot 
  • Skin discoloration or redness near the bump 

As the bump develops over time, symptoms may not appear until the bone grows to the point where it causes discomfort. Once you start to notice pain, the pain may worsen as friction between your heel and shoes causes more inflammation. 

Are there any risk factors or groups for Haglund’s deformity?

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Haglund’s deformity is relatively common and can affect any person. However, there are some risk factors associated with the deformity that increase some people’s chances of developing the deformity. Some factors relate to your daily activities and footwear while others relate to your genetics and anatomy. 

You may be at a higher risk of Haglund’s deformity if the following factors apply to you.

  • Sex: Women and people assigned female at birth have a higher risk of the condition. 
  • Age: The deformity most often appears in people 40 years of age or older. 
  • Family history: You are more likely to have Haglund’s deformity if you have a close family member with the deformity. 
  • Foot anatomy: People with a tight Achilles tendon or tight calf muscle are at a greater risk of the deformity. 
  • Walking gait: If your gait puts more pressure on the outside of your foot when you walk, you could be at a higher risk of developing the deformity. 
  • Choice of footwear: Frequently wearing shoes with high arches and that are too tight on your foot and heel increases your risk. 

Physical activity: Sports like ice skating, roller skating, or running can put you at a higher risk of the deformity.

How is Haglund’s deformity diagnosed?

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To confirm a Haglund’s deformity diagnosis, you will need to see your healthcare provider. Because the symptoms of Haglund’s deformity can mimic other foot issues, your physician will be able to review your health history, conduct a physical exam of the foot, and possibly order imaging tests. Reviewing your health history can help assess what your risk for the deformity might be. In addition, a physical exam is essential to understand the symptoms you have been experiencing, what the physical characteristics of the heel are, and what other areas of the foot might be compromised. 

Imaging with the use of an x-ray is necessary in some cases to get a clear image of the bony growth and determine if there is other damage in your foot contributing to your symptoms. It is common for your primary care physician to refer you to a foot specialist called a podiatrist who specializes in conditions of the foot. 

Since Haglund’s deformity can easily cause issues with the Achilles tendon and bursa in the heel, sometimes a magnetic resonance imaging (MRI) is ordered to have a sense of what the soft tissue in the foot looks like in relation to the bone growth. An MRI can also help rule out other conditions like a ruptured Achilles tendon, a heel fracture, or plantar fasciitis. 

How is Haglund’s deformity treated?

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In most cases, Haglund’s deformity is treated with conservative treatments and therapies to help improve symptoms and reduce pain. If the treatment plan works, you can continue to manage the bone growth without the need for any surgery or other invasive treatments. Treatment aims to control inflammation in the heel but will not be able to shrink the bone growth. 

The most common treatment options for Haglund’s deformity are described below. 

Exercise and Stretching: Sticking to a regular routine of stretches and exercises that can help alleviate Haglund’s deformity is one of the most effective treatments. Exercises such as heel raises and drops help stretch and strengthen the foot to relieve pain. 

Medication and Icing: Over-the-counter pain relievers and anti-inflammatory drugs like ibuprofen or aspirin can help manage the discomfort in your heel. In addition, icing your heels for 20-minute intervals when your symptoms flare up can help with pain and swelling. 

Proper Footwear: People with Haglund’s deformity should aim to find supportive shoes that fit well and do not put pressure on the heel as much as possible. Look for shoes with no backs or backs with soft cushions to limit heel irritation. 

Physical Therapy: Some with persistent Haglund’s deformity pain may find that regular physical therapy can offer relief for inflammation and build back any lost strength or mobility in the foot. 

Orthotic Devices: Orthotic shoe inserts molded to your foot can help support your feet and cushion your heel to prevent inflammation. Other shoe inserts like heel lifts can take the pressure off your foot and heel when walking. 

Surgery: Surgery is rarely needed to treat Haglund’s deformity, but your podiatrist may recommend surgery to correct the shape of the heel bone.

Should you see a doctor for Haglund’s deformity?

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You should see your primary care physician or podiatrist for Haglund’s deformity. While the condition does not pose a risk to your health, the pain can be difficult to manage on your own and without an official diagnosis. It is possible that Haglund’s deformity is only one issue with your foot, so you should see a doctor as soon as you start experiencing symptoms for an accurate diagnosis. 

The condition of your feet may change over time, so be sure to attend your regular checkups and communicate any new or worsening symptoms with your doctor. If the symptoms are bad enough, your doctor may recommend surgery to help relieve pain and re-shape the heel. 

What is the outlook for people living with Haglund’s deformity?

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Beyond pain and symptom management, there are no long-term issues with Haglund’s deformity. Once the deformity develops, you will have it the rest of your life. The deformity is relatively easy to handle with the right treatment. There may be related issues that arise that you will have to diagnose and treat in addition to Haglund’s deformity, so be sure to stay on top of your symptoms and treatment. 

One of the best ways to help improve your foot health and try to prevent further issues is to wear the right shoes, work to strengthen your ankles and heels to avoid injury, and treat your symptoms as they arise instead of ignoring them. Utilizing orthotic devices, such as shoe inserts, can make your daily activities more comfortable and can keep your heel pain to a minimum. You can expect a positive outlook with the right treatment plan for your Haglund’s deformity.

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