Haglund’s Deformity, Bony Protrusion on The Back of The Heel
Haglund’s deformity (aka the Mulhulland Deformity) is a bony enlargement on the back of the heel that most often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone). In Haglund’s deformity, the soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. Haglund’s deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure that aggravates the enlargement when walking. In fact, the deformity is most common in young women who wear pumps.
Haglund’s Deformity is a bony protrusion on the back of the heel. It can occur in one or both feet and often leads to painful “bursitis” (inflammation of the bursa, a fluid-filled sac between the tendon and the bone). In Haglund’s Deformity, the soft tissue near the Achilles tendon becomes irritated when the protrusion rubs against shoes.
Symptoms can include a noticeable bump on the back of the heel, pain in the area where the Achilles tendon attaches to the heel and swelling in the back of the heel. Redness near the inflamed tissue can also occur.
Signs and Symptoms
Haglund’s deformity can occur in one or both feet. The signs and symptoms include:
- A noticeable bump on the back of heel.
- Pain in the area where the Achilles tendon attaches to the heel.
- Swelling in the back of the heel.
- Redness near the inflamed tissue.
To some extent, heredity plays a role in Haglund’s deformity. People can inherit a type of foot structure that makes them prone to developing this condition.
For example, high arches can contribute to Haglund’s deformity. The Achilles tendon attaches to the back of the heel bone, and in a person with high arches, the heel bone is tilted backward into the Achilles tendon. This causes the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to this constant irritation, a bony protrusion develops and the bursa becomes inflamed. It is the inflamed bursa that produces the redness and swelling associated with Haglund’s deformity.
A tight Achilles tendon can also play a role in Haglund’s deformity, causing pain by compressing the tender and inflamed bursa. In contrast, a tendon that is more flexible results in less pressure against the painful bursa.
Another possible contributor to Haglund’s deformity is a tendency to walk on the outside of the heel. This tendency, which produces wear on the outer edge of the sole of the shoe, causes the heel to rotate inward, resulting in a grinding of the heel bone against the tendon. The tendon protects itself by forming a bursa, which eventually becomes inflamed and tender.
After evaluating the patient’s symptoms, the foot and ankle surgeon will examine the foot. In addition, x-rays will be ordered to help the surgeon evaluate the structure of the heel bone
Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the bursitis, they will not shrink the bony protrusion. After evaluating your child’s symptoms, the Orthopaedic Podiatrist will recommend one or more of the following non-surgical treatments:
- Orthotic insoles. These custom-made insoles are helpful because they control the motion in the foot, helping to lessen your child’s symptoms.
- Anti-inflammatory treatments can also help especially topical pain relievers that can be applied directly to your child’s heel.
- Stretching exercises can help relieve tension from the Achilles tendon and are especially important if your child has a tight heel cord. You will be shown how to do these with your child by your Orthopaedic Podiatrist.
- Heel lifts and pads. Children with high arches may find that heel lifts placed inside the shoe decreases the pressure on the heel. Likewise heel pads should help to cushion the heel and reduce irritation when walking.
- Physical therapy. Inflammation is sometimes reduced with certain forms of physical therapy, such as ultrasound therapy.
- Immobilisation. In extreme cases, a plaster cast might be necessary to reduce symptoms.
- If non-surgical treatment fails to provide adequate pain relief, surgery may be needed. The foot and ankle surgeon will determine the procedure that is best suited to your case. It is important to follow the surgeon’s instructions for post-surgical care.
- Appropriate footwear, custom-made orthotic insoles (if necessary) and stretching exercises should help to prevent a recurrence of symptoms from Haglund’s Deformity.
A recurrence of Haglund’s deformity may be prevented by:
- Wearing appropriate shoes; avoid pumps and high-heeled shoes.
- Using arch supports or orthotic devices.
- Performing stretching exercises to prevent the Achilles tendon from tightening.
- Avoiding running on hard surfaces and running uphill
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