Pump bump (Haglund's deformity)

What is Haglund's deformity, and how common is it?

Haglund's deformity is an enlargement of the bony bump at the back-top of the heel bone, often called a pump bump¹. The bump is described as a normal variation that rigid-backed shoes can irritate¹. When it rubs, it can inflame the bursa (a small fluid-filled cushion behind the heel) and the Achilles tendon (the thick tendon at the back of your ankle)². It's usually called Haglund syndrome when the bump is painful and comes with bursa or tendon problems³. It's described as a common cause of pain at the back of the heel⁴.

What causes it, and who gets it?

The exact cause isn't fully known. Family history, the way your foot works and footwear are all thought to play a part³. Footwear is the best-supported trigger for symptoms: a rigid, prominent heel back, especially on a high heel, presses on the tissue over the bump and causes pain and swelling⁵. Tight or poorly fitting shoes, a high foot arch and over-practice in runners may also contribute².

It's mostly described in middle-aged people, more often women, and it often affects both heels². Related tendon problems at the back of the heel become more common with age and in people with diabetes, high cholesterol or an underactive thyroid⁶. It can also occur in people with rheumatoid arthritis⁷.

What does it feel like, and how is it diagnosed?

You'll typically notice pain at the back of your heel, sometimes with limping and swelling, and it's often most noticeable when you start walking after rest². The area over the bump may look red and swollen, usually towards the outer side⁷.

Diagnosis is mainly based on where the pain is and a hands-on examination of the back of the heel and Achilles⁸. A side-on X-ray usually shows the bump², and an ultrasound can help judge how much the tendon is affected⁹. X-ray measurements vary, so the result is read alongside your symptoms and examination, not on its own³⁵.

Other heel problems, such as plantar fasciitis (pain under the heel) and other Achilles tendon problems, can feel similar. Finding the exact spot of tenderness helps tell them apart².

What helps first?

Non-surgical care is the first step, and it helps most people¹⁰. Surgery is only considered if pain continues despite it¹⁰.

Start with your shoes: choose comfortable, supportive shoes that don't put pressure on the heel, and avoid hard heel backs¹¹. A podiatrist can review your shoes and insoles, and may suggest heel pads or lifts if you have high arches². Stretching and physiotherapy may ease tension on the Achilles tendon². Anti-inflammatory medicines are sometimes used, and a pharmacist or doctor can advise on pain relief².

For the related tendon problem, combining strengthening exercise with soft tissue therapy may help⁹. Shockwave therapy has some support, though it can be painful during treatment⁶¹¹. These options can ease pain in the short term⁹, but how well each works for Haglund's deformity itself isn't clear yet, as most of what's known comes from the related tendon problem⁹.

What helps if that isn't enough?

Surgery is the main option once well-conducted non-surgical care hasn't helped. One guideline says to consider it only after at least six months of active treatment, and to talk through the expected benefit and the risks first¹². Options include removing the bump with open or keyhole (endoscopic) surgery¹³, and reshaping the heel bone (calcaneal osteotomy)¹⁴. Keyhole surgery was linked with better function, fewer complications and a shorter recovery than open surgery, though how the two compare head to head isn't clear yet¹³. Surgery carries real risks, such as infection and prolonged swelling¹¹.

A steroid injection around the Achilles tendon can cause the tendon to rupture, and isn't recommended. If one is used, it should be guided by ultrasound¹⁵. If several months of non-surgical care haven't helped, ask your GP or podiatrist about referral to a foot and ankle surgeon.

How long does it take to settle, and can it come back?

Non-surgical care is often most helpful early on, but it may give limited long-term relief when the problem is severe¹¹. Pain where the Achilles attaches to the heel tends to respond less well than pain higher up the tendon⁶. It helps to be patient, and to ask your podiatrist or physiotherapist how long to give each treatment before reconsidering the plan.

No approach has been shown to stop it coming back. Avoiding stiff heel backs that press on the bump makes sense⁵. Ongoing pain is worth having assessed, because untreated Achilles tendon degeneration can progress to partial or complete tears¹⁶.