Haglund's vs Insertional Achilles tendinitis - what's the difference?
At our weekly all-hands-on-deck meeting we drifted into a conversation about the differences between Haglund's deformity (also called a pump bump) and insertional Achilles tendonitis. Both are conditions that are found on the posterior heel and can be very similar in both the location of the problem and the type of pain presented by the problem. But there are a couple of keys to differentiating the two conditions.
First, with a Haglund's deformity, the pain is going to be found adjacent to but not deep to the Achilles tendon. And the pain of a Haglund's deformity is always going to be immediately lateral to the tendon. And finally, Haglund's deformity only has pain while a shoe is on and pressing against the Haglund's bump. Take off the shoe or wear an open-backed shoe like a flip flop or open clog, and the pain goes away.
Achilles tendonitis (also spelled tendinitis), behaves a little differently. Achilles tendonitis will always present with pain at the onset of an activity. The first few steps of a run or the first few steps out of bed are going to be the steps that hurt the most. After a few steps, the tendon warms up and functions without pain. The enlargement found with Achilles tendonitis is circumferential, surrounding the entire insertion of the Achilles (remember, Haglund's was only lateral to the tendon.
But interestingly, both Haglund's deformity and Achilles tendonitis can be treated with the same product - a simple heel lift. I say interestingly because the heel lift works for both conditions but actually works in different ways. For a Haglund's deformity, the heel lift will act to raise the Haglund's bump above the level of the heel counter. The heel counter is the rigid outer portion of the shoe that encases the heel. But for Achilles tendonitis, a heel lift will act to raise the heel, weakening the pull of the Achilles tendon. I guess you could say that a heel lift is the shotgun approach to heel pain in that it can treat Haglund's deformity, Achilles tendonitis, and plantar fasciitis.
Be sure to check out the above links to each condition for an in-depth summary of the problems.
Jeffrey A. Oster, DPM