Haglund’s deformity of the heel bone
Haglund’s deformity is a bony enlargement on the back of the heel bone, known medically as the calcaneus. It is often called a “pump bump” because the rigid backs of pump-style shoes can irritate the area and make symptoms worse. The condition sits at the point where the Achilles tendon attaches to the heel. When the bony prominence rubs against shoes, the nearby soft tissues become inflamed. This includes the retrocalcaneal bursa, a fluid-filled sac that normally cushions the Achilles tendon, and the tendon itself. Over time, the combination of bone, bursitis, and tendon irritation creates a painful cycle.
Causes and Risk Factors
Haglund’s deformity is not just from shoes. Genetics plays a role. Some people are born with a naturally prominent posterosuperior part of the calcaneus. High arches, a tight Achilles tendon, and a tendency to walk on the outside of the heel can all increase pressure on the back of the heel. Footwear is the main external trigger. Stiff-backed shoes, ice skates, and work boots press directly on the prominence. Athletes, especially runners who do hill training, often develop symptoms because of repeated dorsiflexion and rubbing. Women develop it more frequently than men, likely due to shoe choices.
Symptoms and Diagnosis
The hallmark symptom is pain at the back of the heel where the shoe line hits. The area may look visibly enlarged, red, and swollen. Bursitis causes a deep ache that worsens with activity and improves with rest. In chronic cases, the skin can thicken or develop blisters from friction. A doctor diagnoses Haglund’s deformity with a physical exam and X-rays. The lateral X-ray shows the prominent bony bump and may reveal calcification within the Achilles tendon. MRI is sometimes used if the surgeon suspects significant tendon damage or wants to evaluate the bursa.
Conservative Treatment
Most patients start with non-surgical treatment, and many improve without surgery. The goal is to reduce pressure, calm inflammation, and address biomechanics.
Footwear changes
The most immediate step is avoiding rigid heel counters. Open-back shoes, clogs, or sandals take pressure off the bump. For work or exercise, shoes with a soft heel or a cut-out notch can help. Heel lifts of 1 cm reduce tension by slightly plantarflexing the foot, which decreases pull from the Achilles tendon.
Activity and stretching
Runners should cut back on uphill training and reduce mileage temporarily. Daily calf stretching and eccentric Achilles strengthening can reduce tightness. A physical therapist may add ultrasound or iontophoresis to decrease bursal inflammation.
Orthotics and padding
Custom orthotics that control heel motion reduce irritation. Soft heel pads or adhesive gel cushions around the bump, not directly over it, can limit friction inside the shoe. For pronounced inflammation, a walking boot or cast may be used for 2 to 3 weeks to let the bursa calm down.
Medication
Nonsteroidal anti-inflammatory drugs like ibuprofen decrease pain and swelling. Corticosteroid injections into the retrocalcaneal bursa are controversial. While they reduce inflammation, injecting near the Achilles carries a small risk of tendon rupture, so many foot specialists avoid them or use ultrasound guidance.
Surgical Treatment
Surgery is considered when 3 to 6 months of conservative care fails. There are two main approaches and the choice depends on whether the Achilles tendon is involved.
Calcaneal osteotomy / resection
The traditional procedure removes the prominent bone. The surgeon makes an incision beside the Achilles, reflects part of the tendon, and shaves down the posterosuperior calcaneus. The bursa is also removed. Recovery involves 2 to 6 weeks in a boot with limited weight bearing, then physical therapy. Most patients return to regular shoes by 3 months.
Achilles tendon debridement with calcaneoplasty
If the Achilles has degenerative changes or calcium deposits, the surgeon detaches part of the tendon, removes the bone and diseased tendon, then reattaches the tendon with anchors. This is a bigger recovery. Patients are non-weight bearing for 4 to 6 weeks, then progress in a boot. Full return to sport can take 6 to 9 months.
Newer minimally invasive techniques use small incisions and burrs to remove the bump. Early studies show less wound healing trouble and faster return to shoes, but long term data is still evolving.
Prevention and Long Term Outlook
Preventing recurrence centers on shoes and flexibility. Keep the Achilles and calf muscles stretched. Choose shoes with soft backs or no backs when possible. If you have high arches or a tight tendon, orthotics can help redistribute pressure. Most people do well with conservative care. For surgical patients, success rates are around 80 to 90 percent for pain relief, though swelling can linger for months. The main risks are wound healing problems, nerve irritation, and Achilles weakness if too much tendon is detached.
Haglund’s deformity is mechanical. Relieving the mechanical irritation is the foundation of every treatment plan, from heel lifts to surgery.
