With cooler weather coming, and the transition from sandals to shoes with backs, it is important to be aware of foot conditions related to inappropriate footwear. Haglund Deformity, also called “pump bump” or “winter heel” was named after the doctor who first described the condition. As its alternate name suggests, Haglund deformity mostly occurs in response to wearing shoes whose backs put pressure on the back of the heel that causes a bony bump on the upper part of the back of the heel. Originally described as a bony bump on the outer (lateral) upper heel, Haglund deformity can extend across the entire upper back of the heel, and can cause discomfort, pain, swelling, and skin irritation. It is different from insertional Achilles tendonitis (IAT) because the only pathology in Haglund deformity is the bump, not the tendons or nerves or other bones in the foot and ankle.
Who gets a Haglund Deformity?
Haglund deformity occurs most frequently in younger patients, aged mid-teen to 35, although it can occur in others as well. The symptoms include a bony pump on the upper part of the back of the heel, swelling, and skin irritation. To diagnose Haglund deformity, and to rule out other conditions, your podiatrist will perform a physical exam, medical history, and then an x-ray to determine the severity of the bump, and to rule out other conditions and pathologies.
For less severe Haglund deformity, off-loading the area with open-backed shoes, padding the area to relieve pressure, icing to reduce swelling, and treating the skin irritation can help ameliorate the issue. If there are other factors, like biomechanical problems causing the Haglund deformity, orthotic inserts might be necessary. The bump will never go away on its own, although the swelling may reduce. It’s important to wear shoes that don’t put undue pressure on the heel that causes the deformity.
There are several different surgical methods to remove the bony prominence and smooth the heel, as seen in the image to the right. Possible consequences of the surgery can be impairment of Achilles tendon function. The recovery time is relatively quick, with full movement and conventional shoe wear being resumed as soon as the incision wound heels, and swelling reduces. Orthotic inserts may be recommended to prevent the bump from recurring. It’s also important to choose shoes that don’t put undo pressure on your heel.
If your heels are hurting at the end of the day, and you notice swelling on the tops of your heels, you need to look for a different pair of shoes that doesn’t irritate your skin or put pressure on your heel bone. Remember what Newton taught about opposing forces? If your shoes are putting pressure on your heel, that bone is going to push back, and the bony prominence of a Haglund deformity can be the result.