Haglund's Deformity

Haglund's deformity is a bony growth along the posterior lateral border of the calcaneus or the heel bone surrounded by a tender tissue. Haglund's deformity primarily springs from bone enlargement at the back of the heel bone in the area where Achilles tendon attaches to the bone. Hence it is also called pump bump. It is also called as 'retro ocular bursitis and 'calcaneal exotosis'. Bursitis is an inflammation of the sacs (bursae) that contain small amounts of lubricating fluid to help the joints move smoothly. The syndrome is usually found to occur in females in their teens who often use high heels causing irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone. However, the deformity can also occur among runners and athletes. Common symptoms include red painful area in the back of the heel and swollen area at the back of the heel bone. There is irritation in the Achilles tendon. Repeated blistering on the back of the heel leads to callous formation.

Haglund's deformity is identified by physical examination and x rays. The doctor correlates the physical symptoms of redness and pain in the area with findings in x-ray studies, bone scans and MRI. Haglund's deformity can be present at birth or may be acquired by injury over the patient's lifetime. Shoe gear is the primary reason for Haglund deformity. Haglund's deformity can be caused by bursitis or pressure against the shoe.

The treatment for Haglund's deformity depends upon the severity and cause of the disease. During the initial stages when the disease is mild, applying ice followed by moist heat and compression will help ease discomfort from pump dump. Changing the type of shoes can stop the injury and consequent redness and swelling from developing. The pain can also be alleviated to some extent by placing a heel lift inside the shoe so as to lift the Haglund bump above the part of the heel counter of the shoe that rubs it. A doctor may also prescribe anti-inflammatory drugs to reduce pain. Soaking the foot may also soothe the area. In mild cases, a doctor may also recommend padding of the area. Normally corticosteroid injections are given to relieve the pain but for long term complication this injection cannot be recommended as it can weaken and cause rupture to the Achilles tendon. In severe cases of deformity, surgery may be necessary to remove or reduce the bony growth.

Heel Spurs

Heel spurs or plantar fasciitis with reference to the tendons associated with the heel bone is one of most common conditions among athletes. It is also referred to as heel spur syndrome because of its characteristic appearance on the X ray. It is generally caused because of a bony projection under the calcaneus bone. In many cases the pain caused is self limiting. However, the damage caused to the tendons and fibrous tissue around the heel bone can cause radiating pain and extreme discomfort.

The heel bone and the muscles attached to it also known as planar fascia and the soft tissue maintain an arch. This arch drops in case of obesity, faulty running or jumping movements and also because of other factors such as barefoot activities on hard surfaces. The constant exertion of the soft tissue and the muscles associated eventually lead to injury to the respective tissue and also cause a projection which creates an inflammation and pain during contact.

Since heel spurs is associated with sport related injuries and aging, resting the inflamed heel is the first intervention. Often orthopedics recommend anti-inflammatory drugs and sometimes suggest options such as shoe inserts for cushioning and also night splints in order to keep the plantar fascia extended. The contemporary method of treatment for severe heel spurs is extra corporeal shock wave therapy.

Fasciitis Plantar

Plantar fasciitis is the tissue at the bottom of the foot and connects through the toes and the heel bone. When this tissue gets inflamed, the heel begins to pain and this condition is referred to as plantar fasciitis. The pain in the heel is at its peak when you step out of bed first thing in the morning, after a jogging session or after a game of tennis. The pain is severe early in the morning because the tissue contracts during the night and this pain might occur after long periods of standing or while getting up after sitting for a long period. The plantar fascia is called the shock absorber of the feet and supports the arch of the feet. If too much of stress is applied to that shock absorber, it gets inflamed. The major causes contributing to this condition:

Arthritis: People with arthritis tend to suffer with this condition as it causes inflammation to the tendons of the feet.

Excessive physical activity: While indulging in excessive physical activity, the heel bone and the soft tissue on the foot get stressed out too much and lead to plantar fasciitis. Too much strain can be caused while jogging, climbing stairs and walking.

Foot shape: Few people have flat feet and therefore have an odd style of walking thus causing strain to the foot due to uneven distribution of weight on each of the foot.

Ill fitting footwear: Footwear with high heels is a major contributor to feet strain and improper fitting footwear can also cause strain to the feet.

The symptoms for the above condition sets in slowly on one foot, though there are cases where in the pain sets in severely all of a sudden. The following are the most common symptoms:

• Severe pain in the heel, as you step out of bed after waking up in the morning or after continuous standing or climbing the stairs.
  
• Pain right inside the bottom of the heel.
  
• Heel pain after exercising and not during exercises.
  
• Very mild swelling of the heel.
  
• After standing for a prolonged time, pain in the heel or pain in the heel while getting up after sitting for a long period.
  

In normal course home treatment is suggested for such cases; in extreme cases doctors suggest other treatments other than home treatment.

• A splint has to be worn in the night so that it will support the tissue and help it stretch in the morning without much of a strain.
  
• Exercises are suggested to strengthen the lower leg and to stretch the tissue below the heel thereby strengthening it. Athletic taping may be recommended by the physical therapist to support the heel.
  
• Orthotics or shoe inserts are recommended by the doctor so that it will give ample support to the aching heel. Over-the counter inserts are also available.
  

• Maintain ideal body weight.
  
• Use proper fitting footwear and footwear that will give the right support, do not choose too high a heel or too low a heel.
  
• Replace worn out athletic shoes with new ones.
  
• As you wake up in the morning stretch your feet and calf muscles and then set about your normal routine.