Haglund’s deformity, commonly known as “pump bump,” is a bony enlargement on the back of the heel where the Achilles tendon attaches to the calcaneus. This prominent bump can cause significant discomfort, particularly when wearing shoes with rigid backs. The condition results from a combination of bone structure, mechanical factors, and often chronic irritation from footwear. Understanding the spectrum of treatment options available is essential for patients dealing with this painful condition.
Conservative treatment remains the first-line approach for managing Haglund’s deformity, with most patients experiencing substantial relief without requiring surgical intervention. The primary goal of non-surgical treatment is to reduce inflammation and minimize pressure on the affected area. Footwear modification represents one of the most critical conservative measures. Patients should avoid shoes with rigid heel counters, particularly high heels and pump-style shoes that directly press against the bony prominence. Instead, open-backed shoes, soft-backed footwear, or shoes with adequate padding around the heel counter can significantly reduce irritation. Some patients find relief by cutting away the portion of the shoe that contacts the bump, though this may not be aesthetically appealing for all footwear types.
Orthotic devices play an important role in conservative management by addressing biomechanical factors that may contribute to the condition. Custom or over-the-counter heel lifts can reduce tension on the Achilles tendon by slightly elevating the heel, thereby decreasing the force transmitted to the insertion point. Heel pads or cushions can also provide a buffer between the bony prominence and shoe material. For patients with pronation issues or other foot alignment problems, custom orthotics prescribed by a podiatrist may help redistribute pressure and improve overall foot mechanics, potentially reducing strain on the affected area.
Physical therapy and stretching exercises form another cornerstone of conservative treatment of Haglunds deformity . Achilles tendon stretching exercises can reduce tension on the tendon and its attachment point, while strengthening exercises for the calf muscles can improve biomechanics. Ice therapy applied to the area for fifteen to twenty minutes several times daily can help reduce inflammation and pain, particularly after activities that aggravate symptoms. Some patients benefit from ultrasound therapy or other physical therapy modalities that promote healing and reduce inflammation in the soft tissues surrounding the bony prominence.
Anti-inflammatory medications, both oral and topical, can provide symptomatic relief during acute flare-ups of a Haglunds deformity. Non-steroidal anti-inflammatory drugs like ibuprofen or naproxen can reduce pain and swelling when used as directed. Topical anti-inflammatory preparations may offer localized relief with fewer systemic effects. In cases where conservative measures provide insufficient relief, corticosteroid injections may be considered, though these must be administered carefully given the proximity to the Achilles tendon. Injecting steroids directly into the Achilles tendon is generally avoided due to the risk of tendon rupture, but injections into the surrounding bursae may be beneficial for some patients experiencing significant bursitis.
When conservative treatments fail to provide adequate relief after several months of consistent implementation, surgical intervention may be warranted. Several surgical techniques exist for treating Haglund’s deformity, with the specific approach depending on the severity of the condition and the surgeon’s preference. The most common procedure involves excision of the prominent portion of the calcaneal bone, often called a calcaneal osteotomy or exostectomy. During this procedure, the surgeon removes the protruding bone that creates the bump, smoothing the heel contour to eliminate the source of irritation.
Endoscopic techniques for treating Haglunds deformity have emerged as a less invasive alternative to traditional open surgery. Endoscopic calcaneoplasty uses small incisions and specialized instruments to remove the bony prominence, potentially resulting in less soft tissue damage, reduced postoperative pain, and faster recovery times compared to open procedures. However, this technique requires specialized equipment and expertise, and not all surgeons offer this approach.
In cases where retrocalcaneal bursitis significantly contributes to symptoms, bursectomy may be performed alongside bone resection. The inflamed bursa situated between the Achilles tendon and the calcaneus is removed, eliminating this additional source of pain and inflammation. Some surgical approaches also address any insertional Achilles tendinopathy that may coexist with Haglund’s deformity, as these conditions frequently occur together. This might involve debridement of degenerated tendon tissue or, in severe cases, detachment and reattachment of the Achilles tendon to allow for adequate bone resection and tendon repair.
Recovery from surgical treatment for Haglunds deformity typically involves a period of immobilization, initially in a cast or walking boot, followed by gradual return to weight-bearing activities. Physical therapy plays a crucial role in postoperative rehabilitation, focusing on restoring range of motion, strength, and function. Most patients can expect to return to normal activities within three to six months following surgery, though individual recovery times vary. Potential surgical complications include wound healing problems, infection, nerve damage, continued pain, and in cases requiring Achilles tendon detachment, the rare but serious risk of tendon rupture.
The decision between conservative and surgical management of a Haglunds deformity should be made collaboratively between patient and physician, considering factors such as symptom severity, functional limitations, response to conservative treatment, and patient preferences. While surgery often provides definitive relief, the risks and recovery time associated with surgical intervention make conservative treatment the preferred initial approach for most patients. Success rates for both conservative and surgical treatments are generally favorable when appropriate patient selection and technique are employed, offering hope for those suffering from this painful condition.