From the Guidelines
Haglund's deformity should be initially managed with conservative treatments, including referral to a podiatric foot and ankle surgeon, continued initial treatments, and the use of an immobilization cast or fixed-ankle walker-type device if no improvement occurs. The condition is characterized by a bony enlargement on the back of the heel, leading to painful inflammation where the Achilles tendon attaches to the heel, commonly seen in women 20 to 30 years of age, although it can occur in both sexes and at any age 1. Key features of the condition include:
- Acute pain and inflammation aggravated by pressure from shoes
- Pain relief when walking barefoot
- Tenderness lateral to the Achilles tendon, usually in association with a posterior lateral prominence
- Presence of a posterior lateral prominence on radiographs 1. Treatment should focus on reducing pressure and inflammation, with options including:
- Immobilization cast or fixed-ankle walker-type device
- Initial treatments continued under the guidance of a podiatric foot and ankle surgeon 1. It is essential to prioritize conservative management, given the potential risks associated with more invasive treatments, and to consider referral to a specialist if there is no improvement with initial treatments.
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 2.
- 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 clinical feature of Haglund's 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 usually sufficient to make a diagnosis of Haglund's syndrome 2.
- Middle age is the most common age of affection, with females being more affected than males, and the occurrence is often bilateral 2.
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 management can include excision of the posterior calcaneal tuberosity, debridement, and reattachment of the Achilles tendon using bone anchors 3.
- Endoscopic surgery appears to have the advantage of shorter operative times, lower complication rates, and better cosmesis compared to open surgery 4.
Differentiation from Other Conditions
- Haglund's deformity can be confused with Achilles insertional calcific tendinosis, but the two entities can be differentiated clinically and have different surgical management 5.
- Haglund's deformity can also lead to retrocalcaneal bursitis and thickening and inflammation of the calcaneal tendon, a combination of pathologies known as Haglund's syndrome 6.