Haglund's Deformity (Pump Bump)
Haglund's deformity is a bony enlargement at the back of the heel that can rub against stiff shoe heels, causing pain, swelling and an inflamed bursa.
What it is
Haglund's deformity is a bony prominence on the back of the heel bone (calcaneus), where the Achilles tendon attaches. The nickname "pump bump" comes from rigid-backed shoes such as pumps that press on it. The bump itself may be painless; trouble starts when it rubs and irritates the overlying bursa and Achilles tendon.
Causes and risk factors
It is partly down to heel-bone shape, which can run in families, and partly to footwear and mechanics. A high arch, a tight Achilles tendon, and a tendency to walk on the outside of the foot all add pressure to the back of the heel. Stiff, rigid heel counters make rubbing worse.
Symptoms
- A visible, firm bump on the back of the heel
- Pain where the Achilles meets the heel, especially in stiff shoes
- Redness, swelling or a blister-like area over the bump
- Pain that eases in backless or soft-heeled shoes
Conservative treatment
First-line care is non-surgical and aims to reduce pressure and inflammation: open-backed or soft-heeled shoes, heel pads or lifts, anti-inflammatory measures such as ice, calf and Achilles stretching, and sometimes orthotics. Many people improve with these steps alone. A retrocalcaneal bursitis flare may also be settled this way.
When surgery is considered
If pain persists despite months of conservative care, a specialist may discuss surgery to remove the bony prominence and any inflamed tissue. This is reserved for cases that do not respond to footwear and physiotherapy, and recovery takes time.
Frequently asked questions
- Does Haglund's deformity go away on its own?
- The bony bump does not shrink by itself, but the pain often settles once you stop the rubbing with softer or open-backed shoes and treat the inflamed tissue.
- What shoes are best for a pump bump?
- Shoes with a soft, flexible or open heel counter that does not press on the bump. Avoid rigid-backed shoes, and a small heel lift can reduce Achilles tension.
- Is it the same as Achilles tendonitis?
- They often occur together, but they are different. Haglund's is a bony bump; Achilles tendonitis is tendon inflammation. The bump can trigger or worsen tendon and bursa irritation.
Sources & further reading
- Haglund's deformity, www.footcaremd.org
- Heel pain and bursitis, www.mayoclinic.org
- Posterior heel pain, www.apma.org