From the Guidelines
A Haglund deformity is a bony enlargement on the back of the heel bone where the Achilles tendon attaches, causing pain, swelling, and irritation of the surrounding soft tissues and bursa, particularly in women 20 to 30 years of age. This condition is characterized by a posterior lateral prominence, which can be seen on radiographs, and is often associated with tenderness lateral to the Achilles tendon 1. The symptoms of acute pain and inflammation are typically aggravated by pressure from shoes, but relieved when walking barefoot.
Key Characteristics
- The condition is most common in women 20 to 30 years of age, although it can occur in both sexes and at any age
- Symptoms include acute pain and inflammation, aggravated by pressure from shoes
- Tenderness is present lateral to the Achilles tendon, usually in association with a posterior lateral prominence
- The prominence is commonly seen on radiographs
Treatment and Management
Treatment for Haglund deformity typically begins with conservative measures, including wearing open-backed shoes, heel pads or lifts to reduce pressure, and non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. Physical therapy exercises to stretch the Achilles tendon and strengthen foot muscles can also help reduce symptoms. In severe cases that don't respond to conservative treatment, surgical intervention may be necessary to remove the excess bone 1.
Risk Factors
The condition develops due to a combination of factors, including foot structure, walking mechanics, and wearing rigid-backed footwear that puts pressure on the heel. People with high arches or who tend to walk on the outside of their feet are more susceptible to developing this condition.
From the Research
Definition of Haglund Deformity
- Haglund deformity is an abnormality of the bone and soft tissues in the foot, also known as retrocalcaneal exostosis, Mulholland deformity, or 'pump bump' 2.
- It is characterized by an enlargement of the bony section of the heel, where the Achilles tendon is inserted, which can cause irritation to the soft tissue near the back of the heel when it rubs against rigid shoes 2.
Causes and Risk Factors
- The aetiology of Haglund deformity is not well known, but probable causes include a tight Achilles tendon, a high arch of the foot, and heredity 2.
- Middle age is the most common age of affection, with females being more affected than males, and the occurrence is often bilateral 2.
Clinical Features and Diagnosis
- A clinical feature of Haglund deformity is pain in the back of the heel, which is more pronounced after rest 2.
- Clinical evaluation and lateral radiographs of the ankle are mostly enough to make a diagnosis of Haglund's syndrome 2.
- The diagnosis can also be based on clinical signs and radiological images, using the measurement of the parallel pitch lines, in a lateral radiograph of the ankle 3.
Treatment Options
- Haglund's syndrome is often treated conservatively by altering the heel height in shoe wear, orthosis, physiotherapy, and anti-inflammatory drugs 2.
- Surgical excision of the bony exostoses of the calcaneum is only required in resistant cases 2.
- Surgical options include both open and endoscopic techniques, and typically involve excision of the retrocalcaneal bursa, resection of the calcaneal prominence, and debridement of the diseased Achilles tendon 4.
- Endoscopic surgery appears to have the advantage of shorter operative times, lower complication rates, and better cosmesis 4.
Relationship with Insertional Achilles Tendinitis
- Haglund's deformity is frequently associated with insertional Achilles tendinitis, but a study found that a Haglund's deformity was not indicative of insertional Achilles tendinitis and was present in asymptomatic patients 5.
- The study also found that a majority of the insertional Achilles tendinitis patients had calcification at the tendon insertion, and it is possible that removing the Haglund's deformity may not be necessary in the operative treatment of insertional Achilles tendinitis 5.