Haglund's Deformity (Pump Bump)

Quick answer

Haglund’s deformity is a bony prominence at the back of the heel bone (calcaneus). The bump itself doesn’t hurt — what hurts is the soft tissue around it: an inflamed bursa and sometimes the Achilles tendon attachment. The “pump bump” nickname comes from the classic association with stiff-backed pumps that rub on the prominence.

How to recognize it

• Visible bump at the back of the heel, sometimes red or thickened skin over it
• Pain at the back of the heel with stiff-backed shoes
• Tenderness when pressed at the bump
• Worse with high heels, dress shoes, ice skates, ski boots, cleats
• Better in soft-backed or open-backed shoes
• Sometimes coexists with insertional Achilles tendinitis — pain right where the Achilles attaches

What’s actually happening

Three things are typically going on:

1. The bony bump — a prominence at the upper-outer back of the heel bone. Often a normal anatomical variant some people are born with.
2. Retrocalcaneal bursitis — inflammation of the bursa between the heel bone and the Achilles tendon
3. Achilles tendinopathy — irritation where the tendon attaches to the heel

The combination is sometimes called the “Haglund’s syndrome.” Not everyone with the bony bump has pain — symptoms appear when shoe pressure or activity inflames the surrounding tissues.

Why it happens

• Stiff shoe heel counters — pumps, dress shoes, work boots, ice skates, ski boots, cleats all have rigid heel cups that press on the bump
• Repetitive impact — running, especially uphill or in worn shoes
• High arches (cavus foot) — tend to angle the heel, putting more contact on the bump
• Tight Achilles / calf — increases tension at the heel attachment
• Inherited foot shape — the bony anatomy is largely genetic

What to do about it

Conservative care (resolves most cases)

• Change footwear — open-back shoes, soft-back shoes, mules — anything that doesn’t press on the bump
• Heel pads or lifts — raise the heel slightly so the bump sits above the shoe’s heel counter
• Soft padding over the bump (silicone gel sleeves)
• Stretching — calf and Achilles
• NSAIDs for short-term pain
• Ice after activity
• Reduce aggravating activities — running, hill walking
• Custom orthotics with a heel lift for high-arched feet

When initial measures aren’t enough

• Physical therapy — eccentric Achilles loading, calf strengthening
• Walking boot for 2–4 weeks for severe flares
• Steroid injection — used cautiously due to risk of Achilles tendon weakening; never injected directly into the tendon
• Extracorporeal shock wave therapy (ESWT) — option for chronic cases

Surgery (last resort)

For cases that fail 6–12 months of conservative care:

• Bony resection (Haglund’s procedure) — removing the prominence
• Achilles debridement if degenerative changes are present
• FHL tendon transfer for severe Achilles damage

Recovery is significant — typically 6–12 weeks in a boot, gradual return to activity, full recovery often 6+ months.

When to see a clinician

• Pain limiting your shoe choice or activities
• Visible skin breakdown over the bump
• Pain that’s worsened despite shoe changes
• Recurrent flare-ups
• Pain at the back of the heel that’s spreading or getting worse over time
• You have diabetes — closer attention to skin changes is important

Prevention

• Avoid stiff-backed shoes for prolonged daily wear
• Choose shoes with soft, padded heel counters
• Heel pads in shoes that put pressure on the bump
• Stretch calves daily
• Replace worn shoes
• Address tight calves with a stretching routine before they cause issues