Haglund's Deformity

What Is Haglund's Deformity?

Haglund's deformity is a bony enlargement on the back of the heel bone (calcaneus). The soft tissue near the Achilles tendon becomes irritated when the bony bump rubs against rigid shoe backs, leading to painful bursitis (inflammation of the fluid-filled sac between the tendon and bone).

It's often called "pump bump" because the rigid backs of pump-style shoes can contribute to and aggravate the condition. However, any shoes with a stiff heel counter - including men's dress shoes, work boots, and ice skates - can cause problems.

Symptoms

Noticeable bump on the back of the heel
Pain where the Achilles tendon attaches to the heel
Swelling at the back of the heel
Redness or inflammation
Callus formation over the bump
Pain that worsens when wearing closed-back shoes
Relief when wearing backless shoes or going barefoot

Causes

Haglund's deformity is often caused by a combination of factors:

Heredity: Some people inherit a foot structure that makes them prone to this condition
High Arches: This foot type causes the heel to tilt inward, making the back of the heel more prominent
Tight Achilles Tendon: Increases pressure on the heel bone
Walking on the Outside of the Heel: Can wear away the back of the heel
Tight or Ill-Fitting Shoes: Especially shoes with rigid heel counters

Diagnosis

Physical Examination: Evaluating the bump and any signs of bursitis
X-rays: Assessing the shape and prominence of the heel bone
MRI: May be used to evaluate the Achilles tendon and bursa

Treatment Options

Non-Surgical Treatment

Most cases can be successfully managed without surgery:

Footwear Changes: Open-backed shoes, shoes with soft heel counters, or shoes without heel counters
Heel Lifts: Reducing pressure on the heel
Heel Pads: Cushioning inside the shoe
Ice: Reducing swelling and inflammation
Anti-inflammatory Medications: Controlling pain and inflammation
Stretching Exercises: Loosening a tight Achilles tendon
Custom Orthotics: Controlling foot motion and reducing pressure
Immobilization: Walking boot or cast in severe cases

Surgical Treatment

When conservative measures don't provide adequate relief, surgery may be recommended to remove the bony prominence. The procedure may include:

Removal of the enlarged portion of the heel bone
Removal of the inflamed bursa
Repair of the Achilles tendon if damaged

Recovery from surgery typically requires several weeks of limited activity and physical therapy.

Prevention

Avoid shoes with rigid heel backs
Choose shoes with appropriate fit and cushioning
Use heel pads or achilles protectors in shoes
Stretch your Achilles tendon regularly
If you have high arches, consider custom orthotics