Haglund’s Syndrome

Haglund’s syndrome is a condition that describes a bone bump behind the heel bone together with inflammation from the Achilles tendon insertion site. Haglund’s syndrome is also sometimes known as “Haglund’s deformity” or “pump bump.” The condition was observed by doctors to be common in women who wore high-heeled pump shoes hence, the name “pump bump.” However, subsequent research has shown this deformity can happen to anyone irrespective of the kind of shoes you may wear.

The bony enlargement (‘bump’) forms at the attachment of the heel bone to the Achilles tendon. When this bony bump repetitively rubs against rigid shoes, the adjoining soft tissues can get irritated and bone spurs may also occur at the back of the heel. Haglund’s syndrome can result in quite intense pain when walking, prolonged standing or the classic ‘start-up’ pain (pain at the back of the heel after rising from the seated position for the first few steps ).

Causes of Haglund’s Syndrome

Patrick Haglund first coined the term Haglund’s syndrome in 1927. This condition was said to have risen from an unknown reason, hence described as idiopathic. However, doctors and medical researchers have linked this syndrome to several possible factors.

Sometimes, a person’s natural foot structure or condition may make them more prone to Haglund’s syndrome. Some of the features physicians and medical researchers have linked to Haglund’s syndrome include:

• Tight Achilles tendons: This condition may put increased pressure on the heel bone.

• A heel bone that slopes outward: With a prominent heel slope outwards, the tendency of the heel to rub against the backs of shoes naturally increases.

• High arches: This condition is likely to force the heel backward when walking and rub the Achilles tendon.

• Supination: This is the condition when the feet rolls inwards during walking.
• Obesity: There is a weak association between obesity and Haglund’s syndrome.

Haglund’s syndrome can also be caused by wearing certain kinds of shoes. Footwear with rigid backs ( formal work shoes for example ) can cause friction that irritates the back of the foot thereby aggravating a Haglund’s syndrome. It is advisable for people with foot types highlighted above to avoid shoes with rigid backs and make sure their shoes fit snugly.

The shoes commonly link to Haglund’s syndrome symptoms are high-heeled pumps, women’s dress shoes, men’s dress shoes, stiff winter boots, rain boots, ice skates, roller skates, and so on.

Athletes that are involved in high-impact activities or activities with regular start & stop tempo ( such as badminton or tennis ) have been reported to have a higher association with Haglund’s syndrome. Middle-aged patients, more so females, may have a slightly higher tendency to be affected by Haglund’s syndrome.

Symptoms of Haglund’s syndrome

Symptoms typically gradually worsen with time. For instance, pain in the back of the heels deteriorates from mild to a more debilitating level. The following are the symptoms of Haglund’s syndrome:

• Severe pain at the back of the heel where the Achilles tendon attaches to the heel.
• Inflammation like swelling, warmth, tenderness, and redness on the heel.

• Blisters or calluses over the area of the heel where the bump rubs against footwear.

Pain, difficulty wearing shoes and inability to participate in sporting activities are perhaps the commonest presenting complaints.

Diagnosis

With the listed symptoms above, a doctor should be able to identify and diagnose a Haglund’s syndrome. Diagnostic imaging tests such as MRI and X-ray may sometimes be used to check the shape of the heel bone and also to know the severity of the condition. With these tests, a doctor can make a conclusion on which treatment options are best for a patient.

Treatment for Haglund’s syndrome

Non-surgical treatments

The most common treatments doctors’ give to patients with Haglund’s syndrome are non-surgical. None of these treatments can change the structure of the foot and so they serve to provide relief and enable struggling patients to resume their functional activity with reasonable level of comfort. The non-surgical treatments include :

• • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin, help to relieve pain from an inflamed Achilles tendon.
  • Applying ice on the heel to suppress pain and inflammation.

• • Change the kind of shoes you wear; you may put on open-back shoe or change the fit and heel height of your shoes.

• Making use of heel pads present inside the backs of shoes to reduce friction and irritation on the heel. Heel ‘raises’ also help decompress the Achilles tendon thereby reducing the friction phenomenon.
• Reduce or avoid exercises that aggravate the condition.
• Physical therapy can also help bring relief to the condition. Local ultrasound therapy, extracorporeal shockwave therapy and heat therapy all work to reduce the inflammatory load.
• Eccentric loading exercises have also shown to help with Haglund’s syndrome.

• Steroid injections are relative contraindication as they weaken the Achilles tendon and may result in a tendon rupture !
• Surgical Treatment:
  When non-surgical treatments do not relieve Haglund’s syndrome, then surgery will be considered. The purpose of surgery is to remove the part of the heel bone that sticks outwards. Also, surgery may be needed to repair the damaged Achilles tendon. The types of surgery for Haglund’s syndrome are Endoscopic surgery (key-hole) or Conventional surgery and the choice of surgery largely depends on the site and size of the bump.

Prevention of Haglund’s syndrome

To reduce the risk of developing Haglund’s syndrome, the steps to take are the following:

• Stretching, especially eccentric stretching exercises are good.
• Always use ‘supportive shoes’ be if for a high arch or a collapsed flatfoot.
• Once a bump has developed, open back shoes and heel raises may have to be used more regularly.
• If the pain is increasing in frequency, start physiotherapy early.

“For a more expert opinion, please consult Dr. Gowreeson.”