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.
A bony growth formed on a normal bone is termed osteophyte or bone spur. It is an extra bone. Although bone spur can be smooth, it can cause wear and tear with pain in the area when a bone rubs with other bones or soft tissues such as ligaments, tendons or nerves in the body. The most common places in the body where bone spurs occur include the spine, shoulders, hands, hips, knees and heel.
Causes of bone spurs
The body tries to repair itself by building extra bones. These are formed in response to pressure, rubbing and stress that exist over a period of time. Bone spurs can also be formed due to the aging process. Cartilage breaks down and wears away with age. This leads to pain and swelling in some cases when bone spurs are formed along the edges of the joint. When ligaments get tight, bone spurs could be formed. Activities such as dancing and running that lay stress on the feet, excess weight or poorly fitting shoes could lead to formation of bone spurs.
During such times that long ligament gets inflamed and the bone tries to mend itself, a bone spur can form on the bottom of the heel. Pressure behind the heel from frequently wearing shoes that are too tight can cause bone spur at the back of the heel. This is also popularly called 'pump bump' as women who wear high heels suffer from this.
When tendons move through a narrow space between the top of shoulder and upper arm, they rub on the bones. Bone spurs can form in this narrow area. This can pinch the rotator cuff tendons resulting in irritation, inflammation, stiffness, weakness and pain. This condition is called rotator cuff disorder. It occurs with age and due to repetitive tearing of the tendons, especially among athletes, baseball players and in painters who frequently have to work with arms above their heads. Traumatic injury and poor posture can also be potential bone spur causes and can lead to spine bone spurs.
Bone spur symptoms
Signs and symptoms of bone spurs depend upon their location. A bone spur in the knee is painful to the extent that it can bend your legs and prevent the knee from operating smoothly. A bone spur on the vertebra can narrow the space that contains spinal cord and can cause weakness or numbness in the arms and legs. A bone spur in the hip can make movement painful and reduce the range of the hip joint. Bone spurs in the shoulder can hinder rotator cuff movement. Bone spur in fingers appear as hard lumps under the skin and they can make the joints in the fingers look knobbly. When bone spurs begin to press on other bones or tissues thereby causing a muscle or tendon to rub, they can break that tissue can cause swelling, pain, and tearing. Bone spurs in the foot can cause corns and calluses when tissue builds up to provide an added pad over the bone spur.
Bone spur diagnosis
A bone spur is visible through an x-ray. But it is rare to take x ray just to see whether a person has bone spur or not. For instance if an X ray is taken to evaluate, say, an arthritis problem, bone spurs should be visible. During physical exam the doctor can feel around the joints to determine exactly where the pain comes from.
Treatment of bone spurs
As such bone spurs do not require any treatment unless they cause pain and damage to other tissues. Treatment should be directed at the causes, symptoms rather than the bone spurs themselves. Such treatment aimed at the cause of bone spurs include weight loss to take the pressure off the joints and for stretching the affected area when bone spurs occur in the heel cord or at the bottom of the your feet. In the case of plantar fasciitis and shoulder pain, it is better to get an ultrasound done or deep tissue massage on the advice of a physical therapist. Treatment could include rest, ice, stretching and non steroidal anti inflammatory drugs such as ibuprofen. Learn to protect your joints in case you are suffering osteoarthritis. In case of bone spur on the foot, changing footwear or adding padding or a shoe insert may help. A podiatrist may be consulted if the corns and calluses become bigger problems. A doctor could suggest a corticosteroid injection at the painful area to reduce pain and inflammation if the spur continues to cause symptoms. Bone spurs can be surgically removed or treated as part of surgery to repair or replace a joint when osteoarthritis has caused considerable deformity or if the range of motion becomes limited.
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Collection of Pages - Last revised Date: August 1, 2021