A bony growth on the side of the heel, Haglund’s deformity is often the result of wearing hard, inflexible shoes.
What is it?
Also colloquially called “pump bump,” Haglund’s deformity is a bone spur that creates a painful bump on the sides of the heels. The area is red and swollen because it’s irritated, but the skin is not broken.
How do you get it?
Haglund’s deformity is often the result of the persistent use of ill-fitting or uncomfortable footwear, particularly high heels. Heredity has some influence; a person would be predisposed by having a large calcaneus (heel bone) or by walking on the outside of the heel. Most often in the case of Haglund’s deformity, the backs of the shoes press a retracted achilles tendon against the bone of the heel, irritating it. Over time, the body responds to that irritation by creating a bone spur (a type of calcium deposit). The idea is that if the body produces a spur, the bone will thicken so the tendon will stretch and stop pressing so hard on the bone. However, the real problem is the pressure of the shoes pushing the tendon into the bone, so the condition worsens. The calcium deposits get larger, the shoe fits tighter, and eventually, Haglund’s deformity develops.
How is it treated?
The best treatment for Haglund’s deformity is to catch it early and stay away from shoes that put pressure on the back of the heel. If a client has waited too long and the condition is advanced, treatment may include applying ice to the area, taking anti-inflammatory medication, receiving ultrasound treatments to reduce inflammation, or even being fitted for orthotics to provide arch support to the plantar fascia. Finally, stretching exercises add flexibility to the tendons and muscles, providing relief. Surgery is the last option, both because it’s invasive and because recovery is slow. During surgery, the podiatrist makes an incision, moves the achilles tendon out of the way, and scrapes or cuts out the bone spur that has grown on the calcaneus. After surgery, long-term therapy may be needed.
What can a tech do?
While techs won’t be able to offer any long-term solutions to a client with Haglund’s deformity, they may be able to provide temporary relief. Soaking the foot in a warm foot bath and rubbing the area during a massage could provide comfort to some clients. Additionally, it’s likely the client will have tightened calf muscles, so gently massaging those areas may lessen the pain. Techs also have the opportunity to educate the client as to what may be causing the bump. Suggest clients make an appointment with a podiatrist, and in the meantime, choose shoes without a heel and with a soft (or open) back.
At the end of the day, women remove their heels, and the calf muscles, achilles, and plantar fascia are forced to stretch in order to drop the heel. This retracting and stretching seems to work when we are young because we are still flexible. But as we age, we lose flexibility, and the problem becomes more permanent. This explains why a lot of foot-related issues don’t show up until women are in their 30s.
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Dr. Alap Shah contributed to this article.