HAGLUND’S deformity, also referred to as Mulhulland deformity and ‘pump bump’, is a bony enlargement at the back of the heel.

The soft tissue around the Achilles tendon becomes irritated when the tendon rubs against the back of the patient’s shoe. This will often lead to bursitis. Bursitis is inflammation of the fluid-filled sac located between the Achilles tendon and heel bone. As this area becomes more inflamed, the area enlarges and produces pain.

Haglund’s deformity can develop in anyone, however it is more common in people who wear stiff-backed and closed-in shoes; hence the name “pump bump”.

In some cases, it can be hereditary. Highly arched feet cause the heel bone to tilt backwards on to the Achilles tendon. Rubbing occurs, leading to bursitis and thickening of the bone. A tight Achilles tendon can cause compression of the bursa leading to swelling and pain. People who overwear the outside of their shoes are also prone to this condition. As the heel rotates inwards when the patient walks, the tendon grinds against the bone. This again will cause inflammation and bone thickening.

SYMPTOMS

Haglund’s deformity can occur on one or both feet. Patients may have pain and swelling where the Achilles tendon attaches to the heel. The area may be red or have a darker skin tone. There is often a noticeable bump on the back of the heel where the heel bone is thickened.

TREATMENT AND DIAGNOSIS

Diagnosing this condition is sometimes tricky as conditions like Achilles tendonitis can present in a similar way. An X-ray may be required for a firm diagnosis. Treatment is aimed at reducing the pain and inflammation of the bursa.

Remove the irritant. Wear backless shoes that don’t rub on the affected area. Modification of shoes can be carried out by a cobbler.

To reduce the bursa and inflammation, ice packs covered with a towel should be applied to the affected area every four hours for 10-15 minutes. Anti-inflammatory drugs like ibuprofen are also recommended.

Stretching exercises for the Achilles tendon: Your general practitioner or podiatrist will be able to direct you in how to carry this out.

Orthotics: These are manufactured devices that are placed inside shoes to stabilise the foot.

Heel lifts and ultrasound therapy may also be used to treat pump bump. Immobilisation is also an option; in some cases patients are put into casts.

When non- surgical intervention fails, surgery may be indicated. An orthopaedic surgeon will decide what procedure is best for the patient. Surgery is usually followed by a course of physiotherapy to ensure full foot function is resumed.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293-7119), Mandeville (962-2100), Ocho Rios (974-6339), Kingston (978-8392), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.