Introduction:
The origins of Haglund's deformity can be traced back to the 13th century when it was first described. The term "Haglund's deformity" was coined in the early 20th century after Patrick Haglund, a Swedish orthopedic surgeon who extensively studied the condition. However, historical evidence suggests that similar foot deformities were observed even earlier in ancient Egypt and Greece.
What Is Haglund’s Deformity?
Haglund's deformity, also known as "pump bump," is a condition that affects the heel area of the foot. It is characterized by the development of a bony protrusion on the back of the heel bone, causing pain and discomfort. This condition predominantly affects women and athletes, and it can significantly impact daily activities and quality of life. The condition also has other names like Bauer pump and Mulholland deformity.
What Are the Causes of Haglund’s Deformity?
The primary cause of Haglund’s deformity is the constant rubbing of the heel against stiff or rigid footwear, such as high-heeled shoes or ice skates. The friction between the tendon of Achilles and the heel bone causes irritation and swelling of the bursa, which is situated in that area. Over time, the repetitive trauma can cause the bony prominence to develop. Extreme training and practice sessions in athletes have also been associated with this deformity in some cases.
Haglund's deformity is strongly influenced by biomechanical factors in the foot and ankle region. Individuals with a high arch or tight Achilles tendon are more prone to this condition. The high arch creates pressure on the back of the heel, while a tight Achilles tendon puts excessive strain on the bursa and the surrounding tissues.
What Are the Symptoms of Haglund’s Deformity?
Symptoms associated with Haglund’s deformity include:
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The heaviness of the bony protuberance while performing routine activities like walking. This can cause a decreased range of motion in the ankle joint.
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Pain in the backside of the heel. The pain is typically localized to the area where the bony prominence rubs against footwear. It may be described as a sharp or throbbing pain, which can worsen with physical activity or prolonged walking.
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Swelling surrounding the prominence. This is due to constant rubbing and pressure on the bursa and surrounding tissues.
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The affected area may appear red with other signs of inflammation as there is increased vascular supply.
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Tenderness on palpation may be noted.
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In some cases, rubbing against footwear may cause blisters or calluses to form.
How Is Haglund’s Deformity Diagnosed?
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Obtaining medical history is the most important step in diagnosing Haglund’s deformity. The medical professional can diagnose by eliciting the symptoms experienced, the duration and nature of heel pain, any activities or footwear that exacerbate the pain, and any previous foot or ankle injuries.
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This is followed by a physical examination of the foot and ankle. Medical professionals will assess the affected heel for signs of inflammation, swelling, redness, and tenderness. They may also evaluate your gait (walking pattern) and foot mechanics to identify any abnormal foot structures or biomechanical issues that could contribute to the development of Haglund's deformity.
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X-rays are commonly used to confirm the diagnosis of Haglund's deformity and assess its severity. X-rays can help visualize the bony prominence on the back of the heel bone (a posterior superior aspect of the calcaneus) and determine if there are any associated bone spurs. The images can also help rule out other conditions that may present with similar symptoms, such as fractures or arthritis. Sometimes, the healthcare provider may also measure the angle between the bony prominence and the underlying calcaneus. This measurement, known as the "Haglund's angle," helps determine the severity of the deformity. A larger angle indicates a more significant deformity.
How Is Haglund’s Deformity Treated?
The treatment of Haglund's deformity aims to alleviate pain, reduce inflammation, and prevent further progression of the condition. Conservative measures or non-surgical ways are the first line of treatment. These include:
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Rest (Immobilization): Avoiding activities that exacerbate the symptoms, such as running or wearing tight-fitting shoes and heels, can help reduce pain and allow the inflammation to subside.
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Ice Therapy: Ice packs can be placed over the affected heel bone for 15 to 20 minutes and can help in reducing pain and swelling.
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Medications: Over-the-counter pain relievers like Ibuprofen, Acetaminophen, or Naproxen sodium can help with managing the symptoms of inflammation.
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Heel Pads or Shoe Inserts: Cushioning the heel with soft pads or shoe inserts can help reduce friction and pressure on the bony prominence.
If conservative measures fail to provide relief, more advanced treatment options may be considered. These include:
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Physical Therapy: Exercises that stretch and strengthen the heel area can help in improving the flexibility of the Achilles tendon and relieve pressure on the bursa.
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Orthotic Devices: Customized shoe inserts or orthotic devices can help correct foot mechanics and redistribute pressure away from the affected area.
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Complete Immobilization: In severe cases, to immobilize the foot and allow the inflammation to resolve, cast can be used.
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Injection Therapy: Corticosteroid injections into the bursa can provide temporary relief from pain and inflammation.
In rare cases where conservative measures and other treatment options fail, surgery may be considered. The surgical intervention aims to remove the bony prominence, repair the Achilles tendon if necessary, and restore proper foot mechanics.
What Are the Exercises for Haglund’s Deformity?
There are no specific exercises for this deformity. However, exercising can help improve flexibility and strengthen the surrounding muscles. Some common exercises recommended are:
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Stretching the calf muscles can help relieve tension on the Achilles tendon and reduce strain on the bursa.
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Stretching the plantar fascia can be helpful in preventing tightness in the area occurring due to Haglund’s deformity.
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Toe curls help strengthen the muscles in the arch of the foot and reduce strain on the heel.
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Eccentric exercises and range of motion exercises can also be beneficial.
How to Prevent Haglund’s Deformity?
Preventing Haglund's deformity involves making appropriate lifestyle choices and footwear modifications. Opting for shoes with a softer back, low heels, or open backs can significantly reduce the risk of friction and pressure on the heel. Additionally, maintaining flexibility through regular stretching exercises can help prevent tightness in the Achilles tendon and reduce the likelihood of developing this condition.
Conclusion:
In conclusion, Haglund's deformity is a painful condition affecting the heel area. Understanding its causes, symptoms, and treatment options is crucial for individuals who experience heel pain. While conservative measures are often effective, it is important to consult with a healthcare professional to receive an accurate diagnosis and develop an appropriate treatment plan. By taking preventative measures and seeking timely intervention, individuals can alleviate pain and improve their overall foot health.
