deformity is the term used to describe an enlargement of the posterior/lateral
heel. Haglundís deformity also goes by the name of Haglundís disease and pump
bump. Haglundís deformity occurs in patients ranging from the late teens until
the 5th or 6th decade of life. Most clinicians agree that
Haglundís deformity is formed by rolling of the heel into the heel counter, or
rim of the shoe. As a result of the constant pressure of the shoe, reactive
bone forms. Haglundís deformity is common in individuals who wear shoes that
have a rigid heel counter such as ice skates or pump heels.
In addition to reactive
enlargement of the heel bone, chronic pressure to the posterior/lateral heel
often results in bursitis of the heel. This particular bursal sac forms between
the heel and skin. Inflammation of the bursal sac, called bursitis, can be
quite painful and limit and individualís ability to wear shoes.
Treatment of Haglundís
Conservative care of
Haglundís deformity focuses on avoiding direct pressure on the back of the
heel. Shoes that have a rigid heel counter should be avoided. Open back shoes
like clogs and flip-flops can help by simply decreasing direct pressure to the
posterior heel. When closed heel shoes are required, a
heel lift can
be used to raise the heel above the heel counter.
Use of oral
anti-inflammatories and cortisone are not particularly effective if direct
pressure to the posterior heel continues. Although anti-inflammatories may help
to ease pain, the primary cause of Haglundís deformity is mechanical due to
direct pressure from the shoe.
evaluation of a Haglund's deformity includes assessment of the heel with a
lateral x-ray of the foot. The reactive bone deposit on the posterior heel
in a Haglund's deformity can be visualized. As a result, the heel which is
normally round in the back becomes square like the head of a tomahawk.
This increase in bone on the back of the heel is measured by an angle called the
Phillip-Fowler angle. An increase in the Phillip-Fowler angle suggests
hypertrophy of the posterior heel
Surgical care of Haglundís
deformity focuses on resection of the posterior/lateral bump of the heel. Most
cases of Haglundís deformity can be corrected without displacement of the
Achilles tendon from the back of the heel. The advantage of keeping the
Achilles tendon intact is that patients are able to ambulate immediately
post-op. If the Achilles tendon does need to be moved or is weakened during the
surgery, patients are placed in a below the knee cast for 6-8 weeks to allow for
adequate healing of the tendon.
In severe cases of Haglundís
deformity, a Keck and Kelly procedure may be performed. A Keck and Kelly
procedure is a wedge resection of the calcaneus that results in the shortening
of the calcaneus. A Keck and Kelly procedure would be performed in conjunction
with a partial resection of the posterior heel.
Surgical resection of a
Haglundís deformity (without a Keck and Kelly procedure) is performed on an
out-patient basis using either a general anesthetic or local anesthesia with
sedation. The procedure takes approximately and hour to complete. This
procedure is typically performed in the prone position. Healing from this
surgery does vary, but most patients are back into a regular shoe at 4-6 weeks