Introduction

Sometimes the shape of a bone can cause problems in the foot. One example of this is Haglund's deformity, a condition caused by a prominent bump on the back of the heel.

Anatomy

The heel bone (calcaneus) is the largest bone of the foot. The large Achilles tendon attaches to the back of the calcaneus. Resting between the bone and the Achilles tendon, a lubricated sac of tissue (bursa) allows the tendon to slide easily against the bone during movement of the foot. Bursae can be found anywhere body tissues must move against one another.

Causes

Pressure on the back of the heel from shoes is the primary cause of Haglund's deformity. People who have a prominent bump underneath the attachment of the Achilles tendon are more likely to develop Haglund's deformity. This prominent bump squeezes the soft tissues between the bone and the back of the shoe. Over time, the soft tissues may become inflamed and may thicken.

Symptoms

The primary symptom of Haglund's deformity is pain at the back of the heel. The tissues also may thicken over the bone bump forming a callous. The callous can grow quite thick and become inflamed while you are wearing shoes. The bursa on the back of the heel can become swollen and inflamed as well.

Diagnosis

A surgeon will review your medical history and perform a physical examination. The condition may be obvious from the appearance of the back of the heel. X-rays allow the surgeon to see how the calcaneus is shaped and to make sure there is no other cause for your heel pain. Generally no other tests are required.

Treatment

Treatment usually begins with nonsurgical, or conservative, measures. Surgery usually is considered when all conservative measures have failed to control your problem.

Conservative Treatment

One way to remove pressure from the back of the heel is to wear shoes with no back, such as clogs. If you must wear shoes with backs, pads over the back of the heel may give some relief. Staying out of shoes as much as possible will reduce the inflammation and pain due to Haglund's deformity.

Surgery

Several surgical procedures are designed to treat Haglund's deformity. The goal of these procedures is to reduce the prominence on the back of the heel relieving pressure from the shoe. Over time the thickened tissues will shrink back to near normal size if the pressure is removed.

Many surgeons simply remove the bump. This procedure is performed through a small incision on the back of the heel. The Achilles tendon is moved to the side so the surgeon can see the back of the calcaneus. Some bone is then removed, and the calcaneus is shaped to relieve the pressure. The incision is closed with stitches. A large dressing and a splint will protect the foot while it heals.

Another surgical procedure known as a wedge osteotomy removes a wedge of bone from the calcaneus, shortening it. This procedure is performed much the same as removing the bump.

Rehabilitation

Following surgery, you may need to use crutches for several weeks. Your stitches will be removed in ten to fourteen days (unless they are the absorbable type, which will not need to be removed). You should be released to full activity in about six weeks.