From the Guidelines
Haglund's deformity should be initially managed with conservative measures, including wearing open-backed shoes, heel pads, ice application, and over-the-counter anti-inflammatory medications, with referral to a podiatric foot and ankle surgeon if no improvement occurs 1. When treating Haglund's deformity, it is essential to address the symptoms of acute pain and inflammation, which are often aggravated by pressure from shoes. Key characteristics of this condition include:
- Tenderness lateral to the Achilles tendon
- A posterior lateral prominence, commonly seen on radiographs
- Pain relief when walking barefoot Conservative treatments may include:
- Wearing open-backed shoes to reduce pressure on the heel
- Using heel pads to cushion the area
- Applying ice to reduce inflammation
- Taking over-the-counter anti-inflammatory medications, such as ibuprofen or naproxen, for pain relief If these measures are unsuccessful, referral to a podiatric foot and ankle surgeon is appropriate, with potential use of an immobilization cast or fixed-ankle walker-type device 1. It is crucial to prioritize conservative management and consider surgical options only when these treatments fail, given the potential risks and complications associated with surgery.
From the Research
Definition and Causes of Haglund's Deformity
- Haglund's deformity, also known as retrocalcaneal exostosis, Mulholland deformity, or 'pump bump,' is an abnormality of the bone and soft tissues in the foot 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.
- The aetiology of Haglund's deformity is not well understood, but probable causes include a tight Achilles tendon, a high arch of the foot, and heredity 2.
Clinical Features and Diagnosis
- The condition is commonly associated with pain in the back of the heel, which is more pronounced after rest 2.
- Clinical evaluation and lateral radiographs of the ankle are typically sufficient to make a diagnosis of Haglund's syndrome 2.
- Middle-aged individuals are most commonly affected, with females being more affected than males, and the occurrence is often bilateral 2.
Treatment Options
- Conservative treatment options include 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, including both open and endoscopic techniques, typically involve excision of the retrocalcaneal bursa, resection of the calcaneal prominence, and debridement of the diseased Achilles tendon 3.
- Endoscopic surgery appears to have the advantage of shorter operative times, lower complication rates, and better cosmesis 3.
Complications and Related Conditions
- Haglund's deformity can lead to retrocalcaneal bursitis, a significant cause of posterior heel pain 3.
- It can also contribute to Achilles tendon disorders, including tendinosis, paratenonitis, insertional tendinitis, and frank rupture 4, 5.
- In rare cases, Haglund's deformity can cause acute Achilles tendon rupture, which may require surgical treatment with tendon debridement and reattachment 5.