Haglund’s syndrome, or insertional tendinitis of the Achilles, is a common cause of heel pain. The primary cause is abnormal mechanics of the Achilles tendon, causing damage at the Achilles attachment. This leads to bony enlargement at the back of the foot where the Achilles tendon inserts into the heel bone. Also known as retrocalcaneal exostosis, Achilles bursitis, Mullholland deformity, and ‘pump bump’, this condition causes pain when the soft tissue at the back of the heel becomes irritated from repeated rubbing against tight or rigid shoes. This can lead to bursitis, an inflammation of the fluid-filled sac between the tendon and bone. The pain tends to develop slowly over time, causing the tendons to thicken and become inflamed. Bone spurs will occur at the back of the heel as well.
The cause seems to be related to weight, high-impact activities, a tight Achilles tendon and calf muscle complex. It can also develop in people who wear ill-fitting shoes that rub or cut into the back of the heel. Athletes such as skaters, who wear tight fitting shoes are also at risk. Haglund’s syndrome tends to affect middle aged people, females more than males, and is often bilateral (in both feet).
People with Haglund’s syndrome will have a bony bump at the back of the heel, and experience severe pain in the back of the foot, where the Achilles tendon attaches to the heel. The heel area may become red and swollen and may be warm and tender to the touch. People often have difficulty wearing shoes when the condition flares up.
In most cases, Haglund’s syndrome can be treated conservatively through rest, NSAIDs such as aspirin or ibuprofen, and ice. Patients are advised to wear open back shoes and change the fit and heel height of everyday footwear. Exercises to stretch the Achilles tendon, physical therapy and steroid injections are also effective non-surgical options. Surgery to shave down the enlarged bone, repair the Achilles tendon, or adjust the biomechanics of the Achilles tendon as it reaches the heel, is only required after all non-surgical options have failed to provide pain relief.