Haglund’s deformity is a commonly seen but not well understood condition also known as retrocalcaneal exostosis. An abnormality of the heel bone and soft tissues cause a fairly prominent bony bump at the back of the heel to appear. Although not medically dangerous, Haglund’s deformity is painful and can lead to other complications, let alone causing problems with comfortable shoe fit.
Symptoms
A prominent bony bump on the posterior aspect of the heel will appear, particularly at the attachment site of the Achilles tendon, on the posterosuperior part of the calcaneus. The bump will be painful and uncomfortable, and the surrounding area may become inflamed and present as tender, red, and swollen. Symptoms of Haglund’s deformity can mimic other conditions of the heel, including plantar fasciitis, retrocalcaneal bursitis, and Achilles tendonitis. However, the signature bump and x-rays are usually sufficient to make a Haglund’s deformity diagnosis.
As the bump rubs against the person’s shoes, the surrounding area can also become irritated and inflamed, causing retrocalcaneal bursitis, calcaneal tendon bursitis, as well as thickening and inflammation of the calcaneal tendon.
Etiology
Constant pressure and friction on the heel bone will result in inflammation of the area, which stimulates calcium build up in the bone and surrounding soft tissues. This causes the bone to enlarge which leads to further pain and irritation.
Although Haglund’s deformity has no definitive etiology, but a variety of likely causes have been proposed. Lifestyle factors may also contribute, including the consistent use of ill-fitting shoes. This is evidenced by the usual patient population who is affected. Haglund’s deformity typically affects middle-aged women, who may be more likely to have a history of wearing high-heeled shoes.
Individual biomechanics and physiology are likely to play a major role. High arch foot types and those with a tight Achilles tendon are more susceptible to this condition, and hereditary factors may be at play. In addition, those with altered biomechanics of the foot joints, poor posture, or misaligned subtalar joint are more likely to experience this condition.
Treatment
Conservative treatment is effective in the majority of cases, and will be dependent on the individual cause of the deformity. The goal for every treatment will be to primarily reduce pressure on the heel bone, relieve the pain, and to prevent recurrence.
Conservative treatments may include custom made foot orthotics, shoe modifications, physiotherapy and stretching exercises, icing, and anti-inflammatory medication.
Orthotic treatment should include heel raises and heel pads. A thorough biomechanical assessment should be conducted, including gait analysis. If the cause of the deformity is related to a biomechanical abnormality, it will be important to re-position the foot with orthotics so as to prevent recurrence.
If conservative treatment is not effective, then surgical options are recommended to reduce the bone mass.
