Today I’m going to talk about something called a Haglund’s deformity. It’s also popularly knows as a pump bump. Essentially what this deformity is an enlargement of the bone at the top back aspect of the calcaneus or heel bone. You would be able to feel this particular enlargement by feeling the back of your heel and feeling a large bony prominence, just above the area where you ca feel your Achilles tendon stop.
This condition is caused by a number of different things. Sometimes the bone on the back top aspect of the heel bone can become irritated by things such as the backing of the shoe. It can be irritated because of traction on it from fibers that attach from the Achilles tendon which runs just a little bit in front of that, and also some people might simply be born of an enlargement of this bone itself.
The problem with this enlargement is that it can sometimes create pain and inflammation in the tissues that lie over it because once you start wearing a shoe that happens to catch the heel just right, this irritation can start as the shoe pushes against the skin and the tissue underneath that, which then is pushed against this bump on the heel bone itself. When this inflammation starts, it can continue despite not even wearing the particular shoe that caused it in the first place.
Oftentimes this condition can also be associated with spurs that actually grow on the back of the heel bone itself a little bit further away from where this Haglund’s deformity is at. The spurs that typically tend to grow right near where the Achilles tendon attaches to the heel bone itself and so those often contribute as well to this pain. In addition to the inflammation of the tissue overlying this bump, the Achilles tendon itself also becomes inflamed and irritated, and so the whole area on the back of the heel begins to hurt.
How do you treat a a Haglund’s deformity?
Treatment basically starts out fairly simple. Certainly you have to address things like the Achilles tendon and making sure that the inflammation in the Achilles tendon goes away. That’s done by basically stretching the Achilles tendon and making it much more limber as well as putting some ice behind that area to reduce the inflammation and taking anti-inflammatory medications. An important part of this is wearing shoes that don’t necessarily have a hard area on the back of the shoe that’s going to push in or directly irritate the bone behind the back of the heel itself.
If this isn’t done, sometimes that bone enlargement can get even larger because of the stimulation of the irritation on the bone from the shoe and so the problem can get even worse. Sometimes physical therapy is also necessary in order to reduce the inflammation if the other measures I had talked about aren’t successful. Another simple solution that can also help in addition to the stretching is wearing a heel lift which actually lifts the heel up a little bit and does not make the heel have to work as hard in order to function because there will be less bending and less stretching as required of the Achilles tendon. It essentially gives the Achilles tendon a little bit more slack.
Now, if all these measures don’t help, then it’s time to have to consider surgery in order to provide pain relief. Surgery is performed for this condition every single day. It’s a little bit tougher to recover than a lot of other different types of procedures. If all you have to do is remove the Haglund’s deformity, if the Achilles tendon itself is fine, if there’s not a lot of spurs on the back of the heel bone itself, the procedure is not as difficult. Essentially, you just go in and the bump that’s irritating the overlying skin is simply shave down.
However, if there are a lot of spurs coinciding with this on the back of the heel, the Achilles tendon itself is going to have to be removed from the heel bone, the spurs have to be cleaned out, and then the Achilles tendon, if it’s damaged or injured, has to also be repaired, and then the whole tendon itself has to be placed back down on the heel bone. Now this is a very important tendon and it has to heal properly. It takes about four weeks for the Achilles tendon to basically seal itself back on to the back of the heel bone. During this time period, the heel has to stay in an absolute locked position so that there isn’t any tearing or ripping of the tendon off away from the bone and so it can heal properly. This requires the use of a cast and crutches in order to stay completely off the foot.
After that four weeks is completed, most people are usually in a walking boot for another four weeks after that in order to protect this weak Achilles tendon as it’s becoming stronger, and a lot of times therapy is also employed during this point or the month after that. Then generally by the third month, most people are able to resume their normal activity and become fully functional again. It’s a little bit of a difficult recovery period than most other foot and ankle surgery but it does the job and once you relieve the back of the heel from either the Haglund’s deformity or the large bump or the spurs that are causing the irritation to the tissue behind there including the Achilles tendon, most people tend to do quite well in the long term.