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Haglund’s (Heel Bump pain)

Painful bump at the back of the heelWhat is a Haglund’s Bump?

  • A Haglund’s deformity is a bony enlargement on the back of the heel bone (Calcaneum).
  • The soft tissues around the  Achilles tendon become irritated at the level of the heel bone (Calcaneum) when the bony enlargement rubs against the back of the shoes.
  • This leads to painful swelling or bursitis, which is an inflammation of the fluid-filled shock-absorbing sac (bursa between the tendon and bone).

Haglund’s deformity was first described over 90 years ago in 1927, by Patrick Haglund, it is also commonly referred to as a retro-calcaneal exostosis and a “pump bump”.

It is a common condition, yet still poorly understood.

It is most commonly seen with middle-aged people. With females being more affected than males, which is thought to be due to footwear styles. It often affects both heels.

Haglund Facts!

Haglund’s bumps will not go away on their own as they are bony, however, the symptoms that are related can be managed.

There is no reason that activities are limited by having Haglund’s such as running and other sports, finding the right shoe and keeping the area comfortable.

What causes Haglund’s?

There is not a definitive cause of Haglund’s, however, the heredity element plays a significant role in Haglund’s deformity. Inherited foot structures and shapes increase the chances of developing this condition, these  include:

  • A high-arched foot.
  • A tight Achilles tendon and calf muscles.
  • A tendency to walk on the outside of the heel.

Shoes with a rigid back, such as football and rugby boots, ice skates, men’s dress shoes, or women’s pumps. The Haglund’s deformity often arises from chronic, low-grade, persistent pressure and friction from the stiff heel portion causes this irritation.

Haglund’s deformity is often referred to as “pump bumps” because the rigid backs of pump-style shoes can create pressure that aggravates the heel when walking.

Heel Bump

What are the common symptoms?

Haglund’s deformity can occur in one or both feet.  Some patients do not get any symptoms.

Symptoms commonly include:

  • A noticeable bump on the back of the 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.
  • Pain when wearing shoes especially in the pushing-off phase of the walking cycle as at this point the heel is  moving within the shoe.

How is a diagnosis made?

  • Clinical examination of the painful area.
  • Taking a thorough clinical history.
  • Imaging such as an x-ray can be helpful to evaluate the heel bone.

Differential Diagnosis

Other causes of pain and discomfort at the back of the heel can include:

  • Rheumatological conditions (Spondyloarthropathies).
  • Gout.
  • Insertional Achilles Tendinopathy where the Achilles attaches to the heel bone becomes inflamed.
  • Calcification of the Achilles usually following previous injury or trauma to the tendon.

What are the Treatments?

Depending upon the degree of pain, and size and duration of your bump, there are several options:

Here is our approach to non-surgical treatments. 

1

Ice

To reduce swelling, apply an ice pack to the inflamed area, placing a thin towel between the ice and the skin.

Use ice for 20 minutes and then wait at least 40 minutes before icing again.

2

Stretching

Stretching exercises help relieve tension from the Achilles tendon.

These exercises are especially important for the patient who has tight calf muscles.

Young sporty woman practicing yoga, doing Warrior one exercise, Virabhadrasana 1 pose, working out, wearing black sportswear, indoor, yoga studio close up. Healthy lifestyle concept

3

Anti-inflammatories

Oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen, can be used to reduce pain and inflammation at the site.

Please read the instructions prior to use and if unsure please ask your Pharmacist/GP/ or specialist.

4

Padding/Protective cover

There are lots of pads and socks with silicone available. In the early stages, we would recommend socks with silicone to cushion and reduce friction at the back of the heel bone providing good protection.

5

Footwear and Lacing style

Shoe Selection. This can be a trial and error scenario, all shoes have different shapes and thicknesses of heel counters (The heel part at the back of the shoe).

Backless or soft-backed shoes or with cushioning around the collar helps avoid or minimise irritation at the heel.

Modifying the lacing pattern of your shoe can create a ‘heel lock’ and prevent heel slippage which is helpful for slim heels and those who are prone to blistering and irritation. See link to technique.

6

Insoles/Orthoses

Orthotic devices – Orthoses are used to support and control the motion in the back of the foot to reduce friction and irritation. for more information about orthoses here is our guide.

Podfo 3d printed device

7

Heel lifts

Patients with high arches often find that heel lifts placed inside the shoe decrease the pressure on the heel.

We would recommend starting with a 3-5mm heel lift.

we would love to help!If you are concerned and have a foot issue why don’t book an appointment

References

Vaishya R, Agarwal A, Azizi A, et al. (October 07, 2016) Haglund’s Syndrome: A Commonly Seen Mysterious Condition. Cureus 8(10): e820. DOI 10.7759/cureus.820

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January 13, 2021 Heel pain , , ,