Haglund's Deformity

Structural and Postural Conditions· Also known as: pump bump, Haglund deformity, retrocalcaneal exostosisUpdated Oct 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026

At a Glance

Haglund's deformity, often called the pump bump, is an enlarged bony bump at the back and top of the heel bone. It is described as a common cause of pain at the back of the heel, though no reliable figure shows how many people have it. The main symptom is a sore, sometimes swollen heel back, often worst when you start walking after rest. Many people settle with changes to footwear, stretches and exercises, but it can take time and some people need further treatment.

What is it?

Haglund's deformity is an enlargement of the bony bump at the back and top of your heel bone. It is often called the pump bump, because stiff-backed shoes such as pumps can rub on it. It is often described as a normal variation in the shape of the heel bone that becomes a problem when shoes irritate it.

When the bump rubs on a hard shoe, the soft tissues next to it can become sore. A small fluid-filled cushion behind the heel bone (the bursa) can become inflamed, and the Achilles tendon (the thick tendon at the back of your ankle) can become thickened and irritated where it attaches to the heel bone.

Haglund's syndrome is the name used when three things happen together: the bony bump, an inflamed bursa behind the heel, and wear in the Achilles tendon where it attaches (called insertional Achilles tendinosis).

Who does it affect?

It is described as a common cause of pain at the back of the heel. For the tendon problem that often goes with it, about 24 per cent of people with heel pain were diagnosed with insertional Achilles tendinopathy (pain and wear where the Achilles tendon meets the heel bone).

It is described mainly in middle-aged people, more often women, and often in both feet. It is also reported in women aged 20 to 40 who carry extra weight or often wear high heels or stiff, low-backed shoes. It can also occur in people with rheumatoid arthritis.

Signs and symptoms

The main symptom is pain at the back of the heel. It is often worst when you start walking after resting. You may limp, and the back of your heel may look swollen or red, usually towards the outer side.

With the tendon problem, you may notice stiffness first thing in the morning and heel pain that gets worse with activity. The area may feel tender and thickened, and bending your ankle upwards may be sore or limited.

What causes it?

The exact cause isn't fully known. Family history, the shape and movement of your foot, and your footwear all seem to play a part.

Shoes with a rigid, prominent heel back, especially with a high heel, press on the soft tissues over the bump. This causes pain and swelling. Other things linked with it include:

tight calf muscles
high-arched feet
feet that roll inwards (overpronation)
extra body weight
tight or poorly fitting shoes
doing too much running too quickly

Heel tendon problems tend to run in families. They become more common with age, and in people with diabetes, high cholesterol or an underactive thyroid. Gout, rheumatoid arthritis and some other forms of inflammatory arthritis can also affect the back of the heel.

How is it diagnosed?

Diagnosis is mainly from your story and an examination. Your podiatrist will ask which shoes you wear and what makes the pain worse. They will press around the back of your heel to find the sore spot and check how well your ankle bends. Pain in the middle of the tendon points to the tendon. Pain more to the side suggests bursitis (an irritated bursa).

A side-on X-ray of your ankle is usually used to show the bump. Different ways of measuring the bump on an X-ray are used, so your clinician will read the result alongside your symptoms and examination. An ultrasound can show how affected the tendon is. An MRI or X-ray can help tell bursitis apart from Haglund's syndrome. Blood tests may be used if arthritis is a possibility.

Other problems can cause heel pain, so finding the exact spot of tenderness matters. Possibilities include bursitis on its own, wear in the Achilles tendon, a tendon tear, plantar fasciitis (the most common cause of heel pain overall), gout and inflammatory arthritis.

Treatment

Treatment without surgery comes first. Surgery is considered only if that doesn't help enough. Much of what is known about non-surgical treatment comes from the closely related tendon problem rather than Haglund's deformity itself. You may need to try a few things and see what works for you.

Looking after it at home

Start with your shoes. Choose comfortable, supportive shoes that don't press on the bump, and avoid hard heel backs and high heels. Tell your clinician which shoes make it worse.

If you have high-arched feet, heel pads or heel lifts may be suggested. Anti-inflammatory medicines, as tablets or gels, are sometimes used to ease pain at the back of the heel. Ask your GP or podiatrist whether they suit you.

Treatment from your podiatrist

Your podiatrist will review your footwear and may suggest heel pads, lifts or orthoses (shoe inserts). Calf stretching and physiotherapy can ease tightness in the Achilles tendon.

Slow, controlled heel-lowering exercises (called eccentric exercises) are often used. Combining them with hands-on soft tissue treatment looks more helpful than the exercises alone. Exercise programmes tend to work less well where the tendon attaches to the heel bone than for problems in the middle of the tendon. This is why it helps to review your progress with your clinician and not just carry on unchanged.

Non-surgical care is often most helpful early on. It may give less lasting relief if the problem is severe.

Other options

Shockwave therapy uses pulses of sound waves to help the tendon heal. It is recommended for the tendon problem at the heel bone, and seems to work better alongside calf stretching. Long-term success is not well shown, and the treatment itself can be painful.

Steroid injections around the Achilles tendon aren't recommended, because they risk the tendon tearing. If one is used, it should be guided by ultrasound.

Surgery

Surgery is considered only if non-surgical care hasn't helped. A common guideline advises at least six months of active treatment first, and surgery may sometimes be considered after three to six months. Your surgeon should talk with you about how much benefit to expect compared with carrying on non-surgical care, and about the risks.

Options include removing the bump, either through a larger cut (open surgery) or small keyhole cuts (endoscopic surgery). Another option is calcaneal osteotomy, where the heel bone is cut and repositioned. Keyhole surgery has been linked with better foot function, fewer complications and a shorter recovery than open surgery.

Surgery carries real risks. Open surgery has an overall complication rate of 12.3 per cent, though this ranges from 0 to 53 per cent between studies. Soft tissue infection after surgery is listed as happening in 1 in every 83 operations. Swelling lasting more than six months is listed as happening in 1 in every 500 operations. See your surgeon, GP or another doctor today if you develop fever, spreading redness, discharge or worsening pain after surgery. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.

Recovery

Treatment without surgery is described as effective for most people, with surgery considered if pain or difficulty walking continues. Results vary, though. In one group of 65 heels with Haglund's deformity, non-surgical treatment worked in 35 per cent.

Take persistent pain seriously. Wear in the Achilles tendon that isn't treated can progress to partial or complete tears, so back-of-heel pain that lasts or gets worse should be assessed.

Preventing it

It isn't yet clear what stops it coming back. Avoiding shoes with a rigid, prominent heel back makes sense, because that kind of shoe presses on the tissues over the bump.

Keep using comfortable, supportive shoes that don't press on the bump. Follow the plan your podiatrist, physiotherapist or surgeon gives you. If progress stalls, ask how long to give each treatment before changing the plan.

When to see a podiatrist

Book an appointment if

Book an appointment with your podiatrist if the bump at the back of your heel is painful, swollen or rubbing in your shoes. See your GP or podiatrist soon if your heel pain hasn't improved after about 2 weeks of home care, is getting worse or keeps coming back. See your GP soon if you have tingling or loss of feeling in your foot, pain in both heels or ankles with a lot of morning stiffness, or heel pain and you have diabetes.

Seek prompt assessment if

Go to the nearest emergency department if your foot or ankle looks out of shape or sits at an odd angle after an injury. See your GP or another doctor today if you have foot or ankle pain after a fall or injury, or you can't move your ankle well, walk or put weight on your foot. See your GP or another doctor today too if you have sudden swelling, redness and warmth around your ankle with a fever, or new unexplained foot or ankle pain and a history of cancer, HIV, TB or inflammatory arthritis. The same applies if the pain comes with feeling unwell, loss of appetite, fever, unexplained weight loss or night sweats. Do the same if the pain began suddenly with a snap at the back of your ankle, even if it feels mild, because it could be an Achilles tendon tear. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.

Frequently asked questions

Is a pump bump the same as Haglund's deformity?

Yes. Pump bump is the everyday name for Haglund's deformity, the bony bump at the back and top of the heel bone. Haglund's syndrome is the term used when the bump comes with a painful, inflamed bursa behind the heel and wear in the Achilles tendon where it attaches.

How is it different from Achilles tendinopathy?

Haglund's deformity is a bump on the heel bone. Insertional Achilles tendinopathy is wear in the Achilles tendon where it attaches to the heel bone, up to about 2 cm up the tendon. The two often occur together, and the bump may be linked with the tendon problem. Your podiatrist can tell you which is causing your pain.

Is this the same as plantar fasciitis?

No. Plantar fasciitis is the most common cause of heel pain overall and is a different problem. Haglund's deformity causes pain at the back of the heel, near the Achilles tendon. Your clinician finds the exact spot of tenderness to tell the two apart, and you can have more than one heel problem.