# Pump bump (Haglund's deformity)

> Haglund's deformity, or pump bump, is a bony bump at the back of the heel that stiff-backed shoes can rub and irritate. Comfortable, supportive shoes that don't press on the bump are the usual first step, with other non-surgical care. Surgery is considered only if that hasn't helped.

Guide in [Heel and arch pain](https://footanklelowerlimb.com.au/learn/topics/heel-and-arch-pain), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/haglunds-deformity
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026.
Next review by 27 October 2027.

- **It's a bony bump at the back of the heel,** often called a pump bump, that stiff-backed shoes can rub and irritate.
- **Shoes come first.** Comfortable, supportive shoes that don't press on the bump are the usual first step.
- **Non-surgical care is tried before surgery,** which is only considered if other care hasn't helped.
- **Some heel pain needs urgent medical assessment,** such as pain after an injury or heel pain with a fever.

## 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 bump [1]. The bump is described as a normal variation that rigid-backed shoes can irritate [1]. 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 problems [3]. It's described as a common cause of pain at the back of the heel [4].

## 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 part [3]. 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 swelling [5]. Tight or poorly fitting shoes, a high foot arch and over-practice in runners may also contribute [2].

It's mostly described in middle-aged people, more often women, and it often affects both heels [2]. Related tendon problems at the back of the heel become more common with age and in people with diabetes, high cholesterol or an underactive thyroid [6]. It can also occur in people with rheumatoid arthritis [7].

## 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 rest [2]. The area over the bump may look red and swollen, usually towards the outer side [7].

Diagnosis is mainly based on where the pain is and a hands-on examination of the back of the heel and Achilles [8]. A side-on X-ray usually shows the bump [2], and an ultrasound can help judge how much the tendon is affected [9]. X-ray measurements vary, so the result is read alongside your symptoms and examination, not on its own [3][5].

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 apart [2].

## What helps first?

Non-surgical care is the first step, and it helps most people [10]. Surgery is only considered if pain continues despite it [10].

Start with your shoes: choose comfortable, supportive shoes that don't put pressure on the heel, and avoid hard heel backs [11]. A podiatrist can review your shoes and insoles, and may suggest heel pads or lifts if you have high arches [2]. Stretching and physiotherapy may ease tension on the Achilles tendon [2]. Anti-inflammatory medicines are sometimes used, and a pharmacist or doctor can advise on pain relief [2].

> [!tip] Try this
> Run your hand inside the heel of the shoes you wear most. If the back is hard or presses on the bump, try a pair with a softer, cushioned heel back, and wear the stiff pairs less for now.

For the related tendon problem, combining strengthening exercise with soft tissue therapy may help [9]. Shockwave therapy has some support, though it can be painful during treatment [6][11]. These options can ease pain in the short term [9], 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 problem [9].

## 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 first [12]. Options include removing the bump with open or keyhole (endoscopic) surgery [13], 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 yet [13]. Surgery carries real risks, such as infection and prolonged swelling [11].

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 ultrasound [15]. 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 severe [11]. Pain where the Achilles attaches to the heel tends to respond less well than pain higher up the tendon [6]. 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 sense [5]. Ongoing pain is worth having assessed, because untreated Achilles tendon degeneration can progress to partial or complete tears [16].

## When to see a podiatrist

See your GP or a podiatrist if your heel pain hasn't improved after 2 weeks of home care, is getting worse or keeps coming back, or comes with tingling or loss of feeling in your foot [17]. If you have diabetes and heel pain, get it seen, as foot problems can be more serious [17]. Pain in both heels or ankles with a lot of morning stiffness is also worth raising [18].

These need urgent medical assessment, from your GP or a podiatrist the same day, or at a Medicare Urgent Care Clinic:

- foot or ankle pain after a fall or injury, a visible deformity of the foot or ankle, or marked loss of movement with trouble walking or putting weight on the foot [18];
- sudden swelling, redness and warmth around the ankle with a fever [18];
- new, unexplained foot or ankle pain if you have a history of cancer, HIV, TB or inflammatory arthritis [18];
- heel pain with feeling unwell, loss of appetite, fever, unexplained weight loss or night sweats [18];
- sudden pain at the back of the heel with an audible snap, which can mean an Achilles tendon rupture [15];
- after heel surgery, fever, spreading redness, discharge or worsening pain.

For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic.

## Common questions

### Will the bump go away without surgery?

Non-surgical care aims to settle the pain and irritation around the bump rather than remove it. Many people improve that way. Whether the bony bump itself shrinks without surgery isn't clear yet. Surgery is usually considered only if pain continues despite well-conducted non-surgical care.

### How is Haglund's deformity different from plantar fasciitis?

Plantar fasciitis causes pain under the heel, while Haglund's deformity causes pain at the back of the heel, over a bony bump. A podiatrist can usually tell them apart by pinpointing where it's tender and examining your heel, so you don't have to work it out yourself.

### What is the difference between Haglund's deformity and Achilles tendinopathy?

Haglund's deformity is a bony bump on the heel bone. Achilles tendinopathy is wear and degeneration of the tendon itself. The kind where the tendon attaches to the heel can be linked with the bump, and the two can occur together, so a podiatrist will check both.

## Further reading

- [Pump bump (Haglund's deformity) on Clindice](https://clindice.com/haglunds-deformity)
- [Haglund’s Deformity: Causes, Symptoms & Treatment](https://my.clevelandclinic.org/health/diseases/25134-haglunds-deformity), Cleveland Clinic
- [G-care: The primary care clinical information system](https://g-care.glos.nhs.uk/clinical-topic/achilles-tendinopathy), NHS
- [Haglund’s Deformity – Pump Bump on Heel | Foot Health Facts - Foot Health Facts](https://www.foothealthfacts.org/conditions/haglund%E2%80%99s-deformity), FootHealthFacts (American College of Foot and Ankle Surgeons)

## Sources

1. Tuberculosis of the calcaneum masquerading as Haglund's deformity: a rare case and brief literature review · Gillott E, Ray P · BMJ Case Reports · 2013. https://doi.org/10.1136/bcr-2013-009252
2. Haglund's Syndrome: A Commonly Seen Mysterious Condition · Vaishya R, Agarwal AK, Azizi AT et al. · Cureus · 2016. https://doi.org/10.7759/cureus.820
3. Prevalence of Haglund deformity in a hospital-based sample in Turkey · Tunç M, Özşahin E, Polat S et al. · Medicine · 2025. https://doi.org/10.1097/md.0000000000045127
4. Surgical treatment for Haglund's deformity · Chen CH, Huang PJ, Chen TB et al. · The Kaohsiung Journal of Medical Sciences · 2001. https://pubmed.ncbi.nlm.nih.gov/11715841/
5. Haglund's deformity and retrocalcaneal bursitis · National Institutes of Health · 1994. https://doi.org/10.1016/s0030-5898(20)31865-4
6. Nonoperative treatment of insertional Achilles tendinopathy: a systematic review · Zhi X, Liu X, Han J et al. · Journal of Orthopaedic Surgery and Research · 2021. https://doi.org/10.1186/s13018-021-02370-0
7. Advance of diagnosis and treatment of Haglund syndrome · Wang J, Zeng X, Ma X · Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery · 2020. https://doi.org/10.7507/1002-1892.201907130
8. Insertional Achilles tendinopathy State of pathology: Insertional tendon tendinopathies · Elkaïm M · Orthopaedics & Traumatology, Surgery & Research · 2026. https://doi.org/10.1016/j.otsr.2026.104974
9. Comparative short-term effectiveness of non-surgical treatments for insertional Achilles tendinopathy: a systematic review and network meta-analysis · Ko VM, Cao M, Qiu J et al. · BMC Musculoskeletal Disorders · 2023. https://doi.org/10.1186/s12891-023-06170-x
10. Correlations between insertional Achilles tendinopathy and haglund's deformity: MRI and radiographic findings · Tang SC, Shih HT, Wu YH et al. · Journal of Orthopaedic Surgery and Research · 2025. https://doi.org/10.1186/s13018-025-06036-z
11. Posterior heel pain · Chelsea and Westminster Hospital NHS Foundation Trust. https://www.chelwest.nhs.uk/your-visit/patient-leaflets/surgery-services/posterior-heel-pain
12. Dutch multidisciplinary guideline on Achilles tendinopathy · de Vos RJ, van der Vlist AC, Zwerver J et al. · British Journal of Sports Medicine · 2021. https://doi.org/10.1136/bjsports-2020-103867
13. Endoscopic calcaneoplasty for the treatment of Haglund's deformity provides better clinical functional outcomes, lower complication rate, and shorter recovery time compared to open procedures: a systematic review · Alessio-Mazzola M, Russo A, Capello AG et al. · Knee Surgery, Sports Traumatology, Arthroscopy · 2021. https://doi.org/10.1007/s00167-020-06362-1
14. Effectiveness of calcaneal osteotomy in surgical treatment of foot conditions: A Prisma statement guidelines compliant systematic review · López-López D, Larrainzar-Garijo R, Becerro-de-Bengoa-Vallejo R et al. · International Wound Journal · 2022. https://doi.org/10.1111/iwj.13745
15. Posterior heel · NHS. https://www.rightdecisions.scot.nhs.uk/ggc-msk-foot-and-ankle/rearfoot/posterior-heel/
16. The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment · Flores DV, Goes PK, Damer A et al. · Radiographics · 2024. https://doi.org/10.1148/rg.230163
17. Heel pain · NHS. https://www.nhs.uk/symptoms/foot-pain/heel-pain/
18. Foot and Ankle Pain · Leicestershire Partnership NHS Trust · 2026. https://www.leicspart.nhs.uk/msk-physiotherapy-resources-getting-started/lower-limb/ankle/

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This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.