Haglund's syndrome

Overview

Haglund's syndrome is a painful condition involving the back of the heel, typically caused by a bony enlargement of the heel bone (calcaneus) known as a Haglund's deformity. This prominence irritates surrounding soft tissues, particularly the Achilles tendon and retrocalcaneal bursa, leading to inflammation and discomfort. The syndrome is common in physically active individuals and those who wear rigid-backed footwear. It is sometimes referred to as "pump bump" due to its association with tight shoes such as high heels.

Causes

Haglund's syndrome results from mechanical irritation at the back of the heel. Contributing factors include:

• Haglund's deformity: A bony enlargement at the posterosuperior aspect of the calcaneus.

• Footwear: Wearing rigid or poorly fitting shoes that rub against the heel.

• Foot structure: High arches, tight Achilles tendons, or a tendency to walk on the outside of the heel increase risk.

• Repetitive stress: Activities such as running, jumping, or walking uphill can exacerbate the condition.

Symptoms

Symptoms of Haglund's syndrome usually develop gradually and may include:

• Pain at the back of the heel, especially where the Achilles tendon inserts.

• Swelling and redness over the affected area.

• Visible bump on the upper part of the heel bone.

• Stiffness or soreness after rest or activity.

• Increased discomfort when wearing tight shoes.

Diagnosis

Diagnosis of Haglund's syndrome is clinical and supported by imaging studies. Common diagnostic steps include:

• Physical examination: Palpation of the heel to assess for tenderness, swelling, and visible deformity.

• X-rays: Used to identify the presence and size of the bony prominence.

• Ultrasound or MRI: To evaluate associated soft tissue involvement such as bursitis or Achilles tendonitis.

Treatment

Treatment aims to reduce inflammation, relieve pain, and address underlying mechanical issues. Options include:

• Conservative management:

  • Wearing open-backed or soft-heeled shoes.

  • Applying ice to reduce swelling.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs).

  • Heel pads, orthotic devices, or shoe modifications.

  • Stretching exercises for the Achilles tendon and calf muscles.

• Injections: Corticosteroid injections may be used cautiously to reduce inflammation, although risk to the Achilles tendon must be considered.

• Surgical intervention: Reserved for severe or persistent cases. Procedures may involve removal of the bony prominence and debridement of inflamed tissues.

Prognosis

With appropriate treatment, most individuals with Haglund's syndrome experience symptom relief and return to normal activities. Conservative therapy is often effective, especially when combined with lifestyle and footwear changes. In chronic or resistant cases, surgery can provide lasting improvement. Preventive strategies, including proper footwear and stretching, can help reduce recurrence.