Haglund's Deformity: Causes, Symptoms, Treatment and Cost

Haglund's Deformity, also known as “pump bump” or retrocalcaneal exostosis, is a common bony deformity that results in a bony enlargement of the area around the Achilles tendon and heel. Haglund's Deformity is more commonly seen in women than men due to their frequent use of hard-soled shoes such as high heels and pumps.

• Classic Haglund's deformity, also known as posterior heel spur: This type of Haglund's deformity is characterised by a small bump on the back of the heel bone. The skin around the area may become red and tender and can cause pain in the soft tissues of the heel with walking and other activities.
• Flexible Haglund's deformity: Unlike classic Haglund's deformity, this type does not have a visible bony prominence on the back of the heel bone. Instead, it is caused by tightness in the Achilles tendon leading to increased pressure when wearing shoes that irritate the tissue at the back of the heel. This type may be more painful when walking due to flexion at the ankle joint as opposed to an increase in pressure from weight bearing activities with classic Haglund's deformity.
• Atraumatic Haglund's Deformity: Also known as 'minimal' or 'reactive' Haglund's Syndrome, this type is similar to flexible Haglunds but does not involve any bony prominence or inflammation in its presentation. Instead, this type of deformity results from repetitive microtrauma caused by shoes that do not fit properly and put excessive pressure on certain areas of your foot while you’re wearing them repeatedly over time again resulting in localised irritation and tenderness if left untreated for an extended period of time before being seen by a surgeon for therapy or surgery.

• Haglund's Deformity is often caused by repetitive or prolonged pressure against this area. The most common ways to get Haglund's Deformity are:
• Wearing high heeled shoes that do not provide enough cushioning for the back of the heel.
• Having a natural flexion in the foot’s arch.
• Having a tight Achilles tendon, which can cause an abnormal walk and thus cause greater stress on this area.

• Pain, redness or swelling at the back of the heel.
• Bony bump on the back of the heel near the Achilles tendon.
• Difficulty wearing shoes due to a pressure point at the back of the heel.
• Limited mobility in certain directions of ankle movement.
• Swelling and tenderness in surrounding soft tissue.

• Wear supportive, cushioned shoes and avoid high heels.
• Avoid pressure to the Achilles tendon area, such as tight collars, straps or socks.
• Limit stiffness in the ankle joint by stretching the calf muscles daily and sticking to low-impact activities that do not stress this tendon.
• Use an ice pack on the affected area after activity or if tenderness occurs.
• Consider wearing a heel cushion pad or an orthotic device to shift pressure away from the back of your foot and relieve discomfort from Haglund's Deformity.

Diagnosis and tests for Haglund's Deformity include:-

• Physical Exam: During a physical exam, a doctor will inspect your foot and ankle, looking for swelling, redness or any other signs of inflammation. The physical exam may also reveal tenderness when pressure is applied to the back of your heel.
• X-ray: An X-ray can help confirm Haglund's Deformity by revealing a characteristic appearance which includes an enlargement of the heel bone (calcaneus) and sometimes an overlapping bony prominence or even an exostosis (bony growth).
• MRI Scan: A MRI scan may be necessary to better diagnose Haglund's Deformity and rule out other potential causes of pain in the affected area (e.g., tendonitis, arthritis). The MRI scan can provide detailed images of soft tissue surrounding the bones which can help identify any changes in shape as well as any possible abnormalities in nearby tendons or ligaments that may be causing pain.
• Ultrasound: An ultrasound can further pin down Haglund's deformities by showing professionals enlarged bones and fluid buildup near nerves and/or tendons which may be causing pain associated with Haglund's deformities.
• Blood Test: To rule out infection or other medical conditions that might be causing symptoms similar to Hagland's deformities, a doctor may order blood tests to identify potential issues beyond just Hagland's deformity itself.

• Soft Tissue Damage: Haglund's deformity can damage the soft tissue, such as bursitis and tendonitis, of the Achilles tendon.
• Achilles Tendon Rupturing: People with Haglund's deformity have an increased risk of their Achilles tendon rupturing.
• Foot Pain: Foot pain is a common symptom of Haglund's deformity due to the pressure placed on it by the enlarging bone spur and tendons along the heel.
• Difficulty Walking: Walking can become difficult due to pain and discomfort caused by Haglund's deformity in some people.
• Arthritis: In some cases, long-term exposure to repetitive strain caused by Haglunds can lead to arthritis in both the ankle and heel joints.

• Massage the affected area with sesame oil and turmeric paste.
• Soak your feet in warm water mixed with castor oil for 15 minutes every day.
• Apply a warm poultice of dry ginger to the affected area for about 30 minutes each day.
• Consume 1 teaspoon of triphala powder mixed with a little honey before going to bed.
• Wear supportive shoes with cushioned soles and lifted heel cups to reduce pressure on the back of the foot.
• Take breaks when standing or walking and elevate your legs whenever possible.
• Avoid tight fitting shoes, high heels, and activities which cause trauma or friction to your heel.

• Eating a nutritious, balanced diet is important when managing a Haglund's deformity.
• Foods that are high in calcium and protein, such as dairy products, lean proteins, beans, and leafy greens, can help to strengthen bones.
• Beneficial fats from foods such as avocados and olive oil can provide anti-inflammatory benefits.
• Eating anti-inflammatory foods such as garlic and turmeric can also help reduce symptoms associated with Haglund's deformity.
• Foods rich in omega-3s, such as fatty fish or chia seeds, are also beneficial for reducing inflammation in the body.
• Vitamin C can help to speed up wound healing so fruits and vegetables that are high in vitamin C should be included in the diet too

• Fried/fatty foods: Fried and fatty foods can increase inflammation in the area and may worsen Haglund's deformity.
• Sodas and carbonated beverages: Sodas and other carbonated beverages can contribute to mineral imbalances, like too much calcium in the area, which can worsen Haglund's deformity.
• Alcohol: Consumption of alcohol should be avoided as it can further increase inflammation and pain associated with Haglund's deformity.
• Salty Foods: Excess salt intake can lead to an increase in swelling, making it even more difficult to find comfort when dealing with Haglund's deformity.

• Regular stretching and physical therapy: Regular stretching and physical therapy can help treat Haglund’s deformity by reducing the pressure on the Achilles tendon and restoring range of motion.
• Orthotic Shoe Inserts: Footwear modifications with orthotics or soft foam heel pad can reduce strain on the bony prominence in Haglund’s Deformity.
• Achilles Tendon Lengthening: In this procedure, a small incision is made in the back of the heel behind the inflamed tissue to expose and cut part of the Achilles tendon to reduce tension on the heel. After surgery, a protective walking cast is used to keep the foot in its new position while it heals over 6 to 8 weeks.
• Calcaneal Osteotomy: In this procedure, an incision is made in front of your ankle so that your surgeon can remove a section of bone from your heel bone in order to change its shape and reduce any pressure points caused by Haglund’s deformity. The area is then protected with screws while it heals over several weeks before you can resume normal activities again.

The best type of healthcare professional to consult for Haglund’s deformity is an orthopaedic surgeon or podiatrist. These healthcare professionals specialise in the diagnosis, treatment and prevention of musculoskeletal diseases and disorders in the foot and ankle.

• Non-steroidal anti-inflammatory drugs (NSAIDs): These are widely used to reduce inflammation and pain associated with Haglund's deformity. Examples include ibuprofen, naproxen, diclofenac, meloxicam, and celecoxib.
• Corticosteroids: These are hormones related to stress and help reduce inflammation and suppress the immune system response in Haglund's deformity cases. Examples include prednisone, methylprednisolone, triamcinolone, and betamethasone.
• Local anaesthetics: These are used to block the transmission of nerve signals that cause pain in Haglund's deformities cases. Examples include lidocaine and bupivacaine.
• Pain medications: These drugs can help reduce pain associated with Haglund's deformity as well as provide relief from other symptoms of the condition such as stiffness or cramping in the involved joint area or heel area. Examples include acetaminophen, codeine or morphine sulphate.
• Bisphosphonates: Bisphosphonates are medications used to treat Haglund’s deformity. These are injected directly into the affected area to reduce pain and swelling. They can also help people with Haglund's deformity by decreasing the size or density of any bony growths in the heel.

Recovery from Haglund’s deformity typically takes 4-6 weeks. The exact duration of recovery depends on several factors such as the severity of the deformity and how compliant the patient is with post-operative care instructions.

• The cost of treatment for Haglund's Deformity in India varies depending on the severity of the condition and the associated complications.
• Generally, the cost of treatment can range from INR 10,000 to INR 50,000 or more.
• The treatment usually involves medication and surgery which can be either a regional or an open technique.
• Additional costs may include physical therapy and special orthotics if required.

Common side effects of Haglund's Deformity treatments include:

• Swelling, pain in the Achilles tendon area.
• Changes in skin texture and colour.
• Numbness.
• Occasionally, an infection or a decrease in range of motion may occur.

  Surgery to correct Haglund's Deformity can also result in scarring and temporary changes to blood circulation in the affected area.

If you are suffering from any haglund's deformity relating to disease then you should consult a doctor nearby as they can cause complications like 'soft tissue damage, achilles tendon rupturing, arthritis' in which treatment course can range from a few months to years depending on the severity of the situation.