Haglund’s deformity is characterized by a bony bump on the back of the heel bone that can become painful when irritated by footwear. When pain occurs, it is usually located in the skin or a soft tissue sac of fluid that forms over the bony bump. This sac is called a bursa and inflammation of it is referred to as bursitis. The original bony bump seems to develop secondary to mechanical irritation of the bone at the point of attachment of the Achilles tendon. A tight achillies tendon may cause traction or pulling injury where it attaches to the heel bone. Natural healing promotes new bone growth in the area, leading to the bony lump on the back of the heel.
Tight shoes or those that slip at the heel contribute to the development of bursitis on the heel. As the bump is rubbed, the skin, bursa and soft tissue along the back of the heel is irritated. Heeled shoes with rigid backs are especially problematic and for this reason, Haglund’s deformity is nicknamed “pump bump.”
The goal of noninvasive treatment of Haglund’s deformity is to reduce the pain and inflammation pain the area. Treatment includes rest, icing for the inflammation and gentle stretching to reduce the pulling of the Achilles tendon. Orthotics are also useful in correcting the alignment of the Achilles tendon, which will also reduce the trauma to the area. The use of non-steroidal anti-inflammatory drugs (NSAIDs) may be suggested, either orally or in gel form, to reduce pain and inflammation. It may be advisable to wear backless shoes when the bursa is acting up. These treatments affect the soft tissue inflammation but do not remove the bony bump. Only surgery can do so but, due to the attachment of the Achilles tendon at the site of the growth, surgery is quite complex and very rarely performed.