Nail & Skin Disorders

What Is Haglund's Deformity?

Anyone who has walked in high heels for any length of time can imagine the origin of Haglund’s deformity.

<p>Haglund's Deformity: A bony enlargement on the side of the heel.</p>

Anyone who has walked in high heels for any length of time can imagine the origin of Haglund’s deformity. In fact, the common, colloquial term for this condition is“pump bump.” Haglund’s deformity is offi cially a bone spur that creates a painful bump on the sides of the heels. The area will be red and swollen because it’s irritated, but the skin is not broken open.

Haglund’s deformity is often the result of persistent use of ergonomically challenged footwear. Of course, heredity has some influence, causing some to be predisposed to the condition. A person would be predisposed by having a large calcaneus (heel bone) or by walking on the outside of the heel. However, even with a predisposition to the condition, a person could likely prevent Haglund’s deformity by choosing shoes that do not put pressure on the heel and the achilles.

High heels are always an issue,” says Alap Shah, a podiatrist at Foot and Ankle of West

Georgia in Columbus, Ga. The calcaneus is the connection point between the legs and the feet. The calf muscle connects to the achilles tendon; the tendon connects to the calcaneus. Under the bottom of the foot is the plantar fascia, a thick band of connective tissue that supports the arch, which also connects “to the calcaneus. The achilles tendon and the plantar fascia don’t connect to each other, but they have an interactive relationship through the calcaneus. When women wear heels, the calf muscle and achilles don’t fully release, and this puts pressure on the plantar fascia. So, all day, that powerful calf muscle is retracted, creating an imbalance, says Dr. Shah. This forces pressure onto the front of the foot. Hence, all the problems in the toes.

At the end of the day, women remove their shoes, and the calf muscles, achilles, and plantar fascia are forced to stretch in order to drop the heel. Dr. Shah. This retracting and stretching seems to work when we are young because we are still flexible, says Dr. Shah. But as we age, we lose flexibility, and the problem becomes more permanent. This explains why a lot of issues don’t show up until women are in their 30s.

In the case of Haglund’s deformity, the backs of the shoes press the already retracted tendon against the bone of the heel, irritating it. Over time, the body begins to respond to that irritation by creating a bone spur. A bone spur is a deposit of calcium that the body lays down to try to add thickness to the area so that the tendon doesn’t have to stretch as much. 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, it becomes Haglund’s deformity.

It’s striking that the condition ever gets to the point of needing surgery because at any time during the painful development a sufferer could make the connection between footwear and friction and change shoes.

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. That doesn’t mean you have to wear matronly shoes. “Avoid shoes with a stiff back,” says Dr. Shah. Also, try to find shoes that pad the area that rubs against the achilles tendon, and look for padded rubber soles at the heel and the balls of the feet.

If 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. The area can’t bear weight for at least six weeks and long-term therapy may be needed.

<p>The runner developed Haglund's deformity due to wearing badly-fitting running shoes.</p>


While techs won’t be able to offer any long-term benefits 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 she make an appointment with a podiatrist, and in the meantime, choose shoes without a high heel and with a soft (or open) back. Depending on the severity of the condition, clients may be able to develop a plan with the doctor that would help them avoid surgery.

“High heels are coming back,” says Dr. Shah. “So we’re going to start seeing a lot more problems.” That puts techs in a position to be on the lookout for early signs of irritation so they can let clients know about a potential problem while it can still be treated conservatively.

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