Haglund's Deformity – The Pump Bump at the Back of the Heel
Haglund's deformity is a painful heel bone bump caused by genetics, footwear, and biomechanics. Learn symptoms, diagnosis, and conservative and surgical treatments.
By Dr. Carli Hoover, DPM
Haglund's Deformity – The Pump Bump at the Back of the Heel
That painful bump on the back of your heel—the one that rubs against the back of your shoes—might be Haglund's deformity. Also called "pump bump," this condition is a bony enlargement that develops on the heel bone, and it can cause significant discomfort. Many people develop Haglund's deformity in their 20s and 30s, sometimes from genetics, sometimes from footwear, and sometimes from activity patterns. Understanding what causes it and how to manage it can help you find relief and get back to comfortable walking.
What Is Haglund's Deformity?
Haglund's deformity is a bony bump that forms on the back of the heel bone (calcaneus) where the Achilles tendon attaches. The AAOS Achilles tendinitis page ties that back-of-heel bump to insertional trouble: the extra bone can irritate the tendon right where it meets the heel. The prominence enlarges and becomes irritated by friction from shoe backs, causing pain and inflammation.
The condition got the nickname "pump bump" because it was historically seen in people who wore pump-style shoes, particularly high-heeled shoes. However, modern cases occur in all types of footwear and in people of all ages and activity levels.
The bump itself is actually a enlargement of the heel bone—the bony projection at the back of the calcaneus. It's not a growth or cyst; it's a structural bony change.
What Causes Haglund's Deformity?
Genetic Factors
Haglund's deformity often runs in families. If your parents have it, you're at higher risk of developing it.
Biomechanical Factors
- Flat feet: Overpronation (foot rolling inward) changes how the heel bone sits and how the Achilles tendon pulls
- High-arched feet: Can create abnormal heel angles
- Tight calf muscles: Create excessive pull on the Achilles tendon, increasing stress on the heel bone
- Ankle structure: Some people naturally have heel bone shapes that predispose them to enlargement
Footwear
- High heels that increase Achilles tendon tension
- Stiff shoe backs
- Tight-fitting shoes
- Shoes with rigid heel counters
- Repeated friction from shoe backs
Activity Patterns
- Running, especially on hard surfaces
- Activities that increase calf muscle tension
- High-impact sports
- Sudden increases in activity level
Inflammatory Conditions
- Arthritis affecting the ankle
- Inflammatory response to repetitive friction
- Achilles tendinitis
Symptoms of Haglund's Deformity
You might experience:
- Visible bump on the back of your heel
- Pain in the back of the heel, especially when wearing certain shoes
- Redness, swelling, or irritation where the heel rubs
- Pain with walking, especially in shoes with stiff heel counters
- Achilles tendon pain
- Pain worse when wearing high heels or certain shoe styles
- Heel pain that improves with different footwear
- Inflammation or bursitis in the area
Diagnosis
Your podiatrist will examine your heel and take a detailed history of your symptoms:
Physical Examination
We'll assess the prominence of the bone, check for swelling and redness, evaluate the Achilles tendon, and determine what footwear triggers your symptoms.
Imaging Studies
- X-rays: Show the bony prominence and its size. Lateral (side view) X-rays are most helpful.
- Ultrasound: Can assess the bursa (fluid sac) that often develops in response to friction
- MRI: Rarely needed but helpful if we suspect significant Achilles tendon involvement
Treatment of Haglund's Deformity
Conservative Management (First-Line Treatment)
Many cases can be successfully managed without surgery:
Footwear Changes
This is often the most important intervention:
- Avoid high heels and pump-style shoes
- Choose shoes with soft, flexible heel counters
- Look for open-back shoes like clogs, sandals, or slip-on styles
- Choose athletic shoes with padded heel collars
- Avoid shoes with rigid heel boxes
- Consider sneakers or supportive walking shoes
Pain Management
- Ice: Apply ice after activities that aggravate the condition
- Elevation: Minimize swelling by keeping your foot elevated
- Anti-Inflammatory Medications: NSAIDs reduce inflammation and pain
- Compression: Elastic bandages or heel sleeves provide support
Heel Padding and Shoe Modifications
- Achilles tendon pads: Specially designed inserts raise your heel slightly, reducing Achilles tension
- Heel lifts: Small lifts in shoe heels reduce tendon tension
- Heel cups: Provide cushioning and reduce friction
- Moleskin or gel pads: Protect the bump area from friction
- Shoe modifications: Professional cobblers can stretch the heel area or modify the shoe back
Physical Therapy
- Calf stretches: Reduce Achilles tendon tension (most important exercise)
- Achilles strengthening: Controlled eccentric exercises
- Other leg stretches: Hip flexor and hamstring stretches reduce overall lower leg tension
Corticosteroid Injections
Can reduce inflammation and pain, though should be used carefully to avoid weakening the Achilles tendon.
Advanced Non-Surgical Options
- Platelet-Rich Plasma (PRP): May reduce inflammation
- Extracorporeal Shockwave Therapy: Stimulates healing and reduces pain
- Immobilization: Temporary use of a boot in severe cases
Surgical Treatment
If conservative treatment fails after 3-6 months:
- Haglund Excision: Surgical removal of the bony prominence. This is the most definitive treatment.
- Achilles Tendon Release: May be performed alongside excision in severe cases
- Bursa Removal: The bursa (fluid sac) that develops in response to friction is also removed
Surgery has high success rates (80-90%) for pain relief, though there's a small risk of Achilles tendon involvement or recurrence.
Prevention and Home Care Tips
To manage Haglund's deformity:
- Stretch your calves: Daily calf stretches are essential
- Avoid high heels: If you must wear them, limit duration
- Choose footwear carefully: Soft, flexible heel counters are your friend
- Pad the area: Gel or moleskin protects from friction
- Wear comfortable shoes: Most of the time, save dressier styles for short periods
- Ice after activities: Reduces inflammation
- Maintain a healthy weight: Reduces pressure on your heels
- Strengthen your feet: Overall foot fitness reduces stress on individual structures
When to See a Podiatrist
Schedule an appointment if:
- You have a painful bump on your heel
- Pain is interfering with your footwear choices or activities
- Conservative measures haven't helped
- You want to explore all treatment options
- You're unsure if you have Haglund's deformity
Living Comfortably with Haglund's Deformity
The good news about Haglund's deformity is that it's highly treatable. For many people, conservative measures—particularly footwear changes and calf stretches—provide excellent relief. You don't have to accept heel pain as part of life or limit your footwear choices unnecessarily.
At the Central Florida Foot & Ankle Institute, we specialize in heel pain and Haglund's deformity. We'll help you find the right combination of treatments—whether conservative or surgical—to eliminate your pain and get back to comfortable walking.
If you're struggling with heel pain from a pump bump, contact us today. Call (407) 307-0006 or book at https://floridafai.intakeq.com/booking to schedule your consultation. We'll develop a personalized treatment plan to get you back in comfortable shoes.