One of the instances where patients come into our office with heel pain, it can be due to pain in the back of the heel, rather than on the bottom. This can be caused by a few different condition - one of which is called a Haglund's deformity. Other terms used to describe this bump on the back of the heel include "pump bump" - as it is irritated by the top back of a high-heeled shoe, or Mulhulland deformity. A Haglund's deformity is when there is a bump on the back of the heel which correlates to a bony prominence of the heel bone - or calcaneus.
This deformity is typically inherited alongside your foot type. There are many people with high-arched feet who develop a halgund's deformity and in some cases people who walk on the outside of their heel can develop this. The culprit is a tight Achilles tendon, or heel cord in combination with a heel bone that is tilted upwards. When the tendon is tight, it pulls on the back of the heel and can cause a spur to develop. In instances of high arched feet, the portion of the heel bone that is normally hidden in front of the tendon can abnormally rub on the tendon itself causing irritation.
A Haglund's deformity can lead to a condition called bursitis, in which a fluid filled anatomical sac fills with fluid in response to irritation. This can result in a localized area of swelling on the back of the heel. In yet other cases, the presence of this bony prominence can cause irritation to the tendon that inserts on this area and in some cases can even cause tearing of this tendon. More superficially, those with a Haglund's often experience blistering on the back of their heel in certain shoes and with new shoes.
In order to alleviate symptoms associated with a Haglund's deformity, treatment can be looked at from two standpoints - conservative or surgical. In conservative treatment, the aim is to reduce irritation on the heel bone through anti-inflammatories and modifying shoegear. Physical therapy can also be of assistance at times. Surgically, this bump can be removed and the tendon elongated in order to facilitate repair of the tendon back onto the heel bone, and this also reduces tightness in the tendon.
If you think you may have a Haglund's deformity and it's slowing you down or prohibiting your ability to do the activities you love - call our office today! With a quick visit and a set of x-rays, we will be able to confirm the cause of your "back of heel" pain and get you on the road to being pain free!!