Haglund's Syndrome - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Haglund's deformity or Haglund’s syndrome is a relatively common condition but is usually poorly understood. It is most commonly seen in middle age, more often affects women than men, and usually appears on both feet rather than just one. The article below describes Haglund's deformity, its symptoms, causes, and how to treat it.

What Is Haglund’s Deformity?

Haglund's deformity is a bony bump or bony enlargement on the back of the heel bone, where the Achilles tendon attaches to the heel. The bony bump often appears red and irritated and flares up occasionally, resulting in pain and swelling.

This deformity usually develops due to friction from the shoe around the area of the natural bony prominence present at the back of the heel. However, abnormalities in foot function, malposition, or a hereditary predisposition may also contribute to the condition. In addition, constant friction from the footwear at the back of the heel can further irritate and inflame the skin, causing changes such as thickening, redness, and increased skin lines.

This condition is occasionally mistaken for other conditions causing pain in the back of the foot, including:

• Achilles tendon calcific enthesopathy (pain at the site where the Achilles tendon attaches to the back of the heel).

• Plantar Fasciitis (inflammation in the tissue that connects the heel bone to the toes).

• Retrocalcaneal bursitis (inflammation of the fluid-filled sacs around the heel bone).

• Seronegativespondyloarthropathies (group of joint disorders).

Other names for Haglund's deformity include:

• Retrocalcaneal exostosis.

• Mulholland deformity.

• Pump bump.

What Are the Symptoms of Haglund’s Deformity?

Haglund’s deformity may occur in one foot but is most commonly seen in both feet. The primary symptoms include the following:

• A bony bump or prominence on the back of the heel.

• Severe pain.

• Swelling in the bursa (fluid-filled sac at the back of the heel).

• Redness due to inflammation of the tissue.

• Calluses or blisters on and around the bony bump due to frequent friction by the footwear.

What Causes Haglund’s Deformity?

Along with potentially misshapen or malformed bone and genetic predisposition, certain factors that can contribute to Haglund's deformity include:

• Walking on the outside of the foot.

• High arches.

• Overtraining in runners.

• A tight Achilles tendon.

• Tight or poor-fitting footwear.

• Joint misalignment with abnormal foot biomechanics.

The type of footwear being worn also has an influence on the development of Haglund’s deformity. Those types of shoes that are often linked with this condition usually have a stiff back. For example,

• Work boots.

• Men’s dress shoes.

• Women’s pumps.

• Ice skates.

How Is Haglund’s Deformity Diagnosed?

The diagnosis of Haglund's deformity can be difficult because the symptoms are similar to other conditions associated with foot issues, such as Achilles tendonitis. It might be possible for the healthcare provider to diagnose the deformity based on the appearance of the heel. The doctor may order an X-ray of the heel bone if they suspect the possibility of Haglund’s deformity. This will help the doctor determine whether the prominent heel bone is associated with the disease. An X-ray may also be helpful for the doctor to create orthotics to relieve the heel pain. Orthotics are shoe inserts that are customized and made to stabilize the foot.

How Is Haglund’s Deformity Treated?

When the bony prominence becomes inflamed, the most essential part of treatment is to minimize the pressure and friction at the area of the bump. The best way of achieving that is to ensure that one wears a shoe that offers adequate support and fits appropriately. Usually, footwear that is a terrible fit will make the condition worse. A variety of conservative treatments aim to minimize pressure and reduce pain and inflammation. However, they do not shrink the bony protrusion itself.

Conservative and nonsurgical treatments include the following:

• Ice packs for 20 to 40 minutes to lessen swelling due to inflammation.

• Stretching exercises for the Achilles tendon.

• Nonsteroidal anti-inflammatory drugs such as Ibuprofen or Aspirin.

• Heel pads to reduce friction and irritation.

• Backless or soft-backed shoes.

• Heel lifts to reduce pressure on the bone for people with high arches.

• Customized orthotics that improve foot biomechanics.

• Immobilization, such as with a soft boot or cast to allow it to heal.

• Night splints.

• Soft tissue massage.

• Physical therapy.

• Ultrasound treatment modalities.

The bony bump can still be painful despite conservative treatments used to reduce the swelling and inflammation in this area. If these less invasive methods do not adequately alleviate the pain, then surgery would be required. Surgery may include the removal of the excess bone or the bump and smoothening and filing of the bone. It usually relieves pain and reduces pressure on the bursa and soft tissues. This results in a return back to a normal lifestyle with no restrictions.

What Are the Complications of Haglund’s Deformity?

When the bony prominence of Haglund's deformity rubs and presses against shoes, it can cause inflammation of other nearby tissues. That can lead to complications, including-

• Bursitis: Bursitis is the inflammation of the fluid-filled sac, called bursa, that provides cushioning to a tendon against bone, can lead to tenderness and swelling.

• Achilles Tendonitis: Symptoms of achilles tendonitis, such as swelling and pain can develop a few centimeters above the area where the Achilles tendon attaches to the bone at the back of the heel.

How to Prevent Haglund’s Deformity?

One can decrease the risk of developing Haglund’s deformity by taking proper care of the feet. It includes:

• Avoid wearing tight, stiff heels shoes, especially for long periods.

• Avoid running uphill or on hard surfaces.

• Choose to wear open-back shoes.

• Wear padded and fitted socks with non-slip soles.

• Perform stretching exercises to prevent stiffening of the Achilles tendon.

Conclusion

Haglund's syndrome is a type of foot deformity that can lead to significant pain and trouble walking. Still, numerous treatment options are available to relieve that pain and, hopefully, prevent it from coming back. So if one notices a hard, bony, painful bump or prominence on the back of the heel, do not wait to bring it up to the notice of the healthcare provider before the condition gets worse and puts one at risk for any complications. The earlier it is detected, one will require only conservative nonsurgical treatments to restore and recover the function and eliminate the pain.