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Houston podiatrist discusses Haglunds deformity, pump bump, and pain on the back of the heelWhen you think of a #HeelSpur, you probably think of a bone spur that grows under the heel bone. There also can be a bone spur that forms on the back of the heel and it can be painful. A #BoneSpur on the back of the heel is known as a Haglund's deformity. It makes it difficult to wear shoes because of the pressure on it. 

A #HaglundsDeformity is a bone spur on the back of the heel. It's caused by the tension of the Achilles tendon pulling on the back of the heel bone. This leads to a bump on the back of the heel that rubs against the back of the shoes. A Haglund's deformity is also known as a "pump bump." This is because of the pressure from the stiff back of a woman's dress shoe. As the heel rocks back and forth as you walk, the bone spur becomes irritated. Very often, I'll see patients come in with a red and inflamed Haglund's deformity. All they're wearing are sandals or other backless shoes, since wearing an enclosed shoe is too painful. Sometimes the back of the heel, even blisters because of the friction in enclosed shoes. Some conditions predispose you to developing a Haglund's deformity. If you have a high arched foot, you have more tension from the Achilles tendon pulling on the heel. 

This makes it more likely for a bone spur to develop. Same thing for a tight Achilles tendon. More tension means spur formation. Abnormal foot biomechanics also contributes to developing a Haglund's deformity. Poor mechanics causes the heel to rock more, which irritates this condition. If the deficiency in foot mechanics is caught early and controlled with a custom orthotic, it can prevent the formation and irritation of a Haglund's deformity. It's straightforward to diagnose a Haglund's deformity. It just takes an x-ray in the office to be able to see the bone spur. Clinical examination is also useful.

If the Haglund's deformity is inflamed, there are a number of conservative treatments that will help alleviate the pain. These treatments will not shrink the bone spur, but will manage the associated inflammation and pain. It's useful to reduce the inflammation. This can be accomplished with oral anti-inflammatory medication or by applying ice. Achilles tendon stretching also help to relieve some of the pressure on the back of the heel. Pads or wearing soft back shoes will help to cushion the bony prominence. 

In severe cases, immobilization in a fracture walker can take the pressure off the back of the heel and allow the inflammation to resolve. Physical therapy is also beneficial to reduce inflammation. In cases where conservative measures do not relieve the pain from a Haglund's deformity, surgery may be necessary. Surgery is not a walk in the park. The Achilles tendon has to be detached from the back of the heel in order to expose the bone spur. The spur is then removed. Afterwards, the Achilles tendon is reattached to the heel bone using a bone anchor. After surgery, you'll have to be non-weight bearing for a period of time. This will allow proper healing. Gradually, you'll be able to bear weight, first wearing a boot, then progressing to athletic shoes.