Haglund deformity, often called “pump bump,” is a common source of persistent pain at the back of the heel. This condition causes discomfort, especially when wearing common types of footwear. Understanding the underlying physical change and contributing factors is the first step toward effective management. This article explains the condition, its causes, identification, and treatment strategies.
What Haglund Deformity Is
Haglund deformity is an abnormality characterized by a bony enlargement, known medically as a posterosuperior calcaneal exostosis, located on the back of the heel bone (calcaneus). This bony prominence forms where the Achilles tendon inserts, creating a noticeable bump that can be seen and felt.
The enlargement causes mechanical irritation of the surrounding soft tissues. The most common associated issue is retrocalcaneal bursitis, which is the painful inflammation of the fluid-filled sac (bursa) situated between the Achilles tendon and the calcaneus. As the bump grows, it pinches the bursa and can also irritate the Achilles tendon, leading to pain and swelling. The combination of the bony deformity, bursitis, and tendon irritation is sometimes called Haglund syndrome.
Why the Deformity Develops
The main cause of painful symptoms is repeated friction and pressure on the bony prominence, primarily from the rigid back of certain shoes. Footwear with stiff heel counters, such as dress shoes, ice skates, or high-heeled pumps, constantly rubs against the exostosis, causing localized inflammation. This external pressure triggers irritation, making the condition known as “pump bump” prevalent among those who wear these styles regularly.
Intrinsic foot structure also plays a substantial role in the development of the deformity. Individuals with a highly arched foot (pes cavus) are more susceptible because the heel tends to tilt backward and roll outward (supination) during walking. This biomechanical alignment increases the pressure and exposure of the heel bone to friction.
A tight Achilles tendon is another contributing factor. A tight tendon pulls on its insertion point on the heel bone, which contributes to the formation and irritation of the exostosis. This combination of foot characteristics and external pressure often dictates who develops the condition and the severity of the symptoms.
Identifying the Signs of Haglund Deformity
The most obvious sign of Haglund deformity is the visible bony bump located on the back of the heel, superior to the Achilles tendon attachment. This enlargement is frequently accompanied by localized redness and swelling, signifying inflammation of the retrocalcaneal bursa and surrounding soft tissue.
Pain is typically felt directly at the back of the heel and worsens when the area is pressed or rubbed by shoe material. Increased pain after periods of rest or when taking the first steps in the morning is characteristic of inflammatory conditions. Diagnosis is usually confirmed through a physical examination and an X-ray, which visualizes the size and shape of the bony exostosis.
Methods for Relief and Recovery
Initial treatment focuses on conservative, non-surgical methods aimed at reducing inflammation and relieving pressure on the heel. A primary step involves modifying footwear to eliminate friction. This often means wearing open-backed shoes, soft-backed athletic shoes, or using protective padding. Heel lifts or pads placed inside the shoe can also be beneficial, as they slightly elevate the heel and reduce pressure on the irritated spot.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are commonly recommended to manage pain and decrease inflammation. Applying ice to the back of the heel for about 20 minutes provides symptomatic relief from swelling. Physical therapy is important for addressing contributing biomechanical factors, specifically through stretching exercises designed to improve the flexibility of the tight Achilles tendon.
If several months of conservative treatment fail to control the pain, a doctor may consider a corticosteroid injection to reduce bursa inflammation, though this is done cautiously due to the Achilles tendon’s proximity. Surgical intervention is reserved as a last resort for chronic cases that do not respond to non-invasive care. The procedure involves removing the bony prominence (excision of the posterior calcaneal tuberosity) and the inflamed bursa (bursectomy). In complex cases, the Achilles tendon may need to be detached and reattached using suture anchors. Full recovery after surgery is lengthy, often requiring several months of rehabilitation.