Haglund’s deformity is a bony bump or ridge that appears on the back of the heel bone. This bump forms where the Achilles tendon attaches to the heel. It may need treatment, such as changing shoes or physical therapy, if it causes pain or difficulty walking.

People also refer to the condition as “pump bump,” as wearing rigid-backed, pump-style shoes appears to aggravate the enlargement. Other shoes featuring rigid backs can also have this effect.

Doctors also talk about Haglund’s syndrome, which involves three conditions:

  • Haglund’s deformity: A bony bump that develops on the back of the heel bone.
  • Insertional Achilles tendinopathy: This is also known as tendinosis, when the enlarged heel bone and the Achilles tendon rub together, leading to a breakdown of the tenon.
  • Retrocalcaneal bursitis: This refers to when a fluid-filled sac develops between the Achilles tendon and the heel bone.

Some people have features, such as the shape of their foot, which increases the risk of developing Haglund’s deformity and Haglund’s syndrome. However, not everyone with the bony lump will encounter all three conditions.

Treatments include shoe modifications and physical therapy. If these do not help, a doctor may recommend surgery to remove the bony ridge or repair the Achilles tendon.

This article discusses how to manage Haglund’s deformity and why it happens.

A doctor will recommend nonsurgical treatments for Haglund’s deformity first.

Although none of these approaches can alter the bone or the foot structure, they may provide pain relief for some people and improve their quality of life.

Some nonsurgical treatment choices include:

  • changing the type of shoes, especially avoiding rigid-backed shoes and pumps
  • placing heel lifts in shoes to help bring the heel up and avoid friction
  • using heel pads inside the backs of shoes to help reduce irritation and friction on the heel
  • inserting footwear arch supports for people with high arches
  • taking anti-inflammatory drugs, such as ibuprofen, to ease pain from an inflamed Achilles tendon or bursa
  • using ice on the heel to help relieve inflammation and pain
  • performing stretching exercises to alleviate a tight Achilles tendon
  • avoiding exercises that aggravate the condition, especially running and running uphill
  • using a soft cast or walking boot to help keep the heel bone from rubbing on the bursa or Achilles tendon
  • trying physical therapy to bring relief

Surgery

If nonsurgical treatments do not relieve symptoms, the doctor may recommend surgery to remove the part of the heel bone that sticks out.

Podiatrists and foot and ankle surgeons can perform different types of surgery to correct Haglund’s deformity. The type of procedure depends on how severe it is, the person’s health history, and lifestyle factors.

Endoscopic surgery is less invasive than traditional surgery. Because it uses smaller incisions than traditional surgery, recovery may be shorter. According to 2018 research, it results in good-to-excellent outcomes in the short and medium term.

However, conventional surgery also appears to have successful outcomes. One study found that most of those who had traditional surgery had relief from their pain at their 1-year follow-up. But, the authors noted that doctors should tell people that the recovery from surgery can be several months.

According to the American College of Foot and Ankle Surgeons, stretching exercises can help relieve tension in the Achilles tendon, especially in people with a tight heel cord.

Here are some exercises that may help.

Heel raise

Using a step, a person can combine the heel raise and heel drop exercise, as in the image below:

  1. Stand with feet flat on the floor and both hands on a wall or holding the back of a chair for support.
  2. Slowly raise the heels so that the balls of the feet support your weight. Hold for a few seconds, then lower the heels.
  3. Hold for 5–10 seconds, and then slowly lower the heels to the ground.
  4. Repeat.

Heel drop

  1. Stand on a low block or stair facing a chair or wall for support.
  2. Move back slightly, so the balls of the feet are on the block, but the heels are off the edge.
  3. Bend the knee of one leg, bringing the foot up behind you, so your body weight is on the standing foot.
  4. Holding on for support, carefully allow the back of the standing foot to drop slightly over the edge of the block.
  5. Hold for 5–10 seconds.
  6. Return to the original position and repeat.
  7. Change feet and repeat.
  8. Do three sets of these, repeating 15 times in each set. Practice 7 days a week for 12 weeks.

Heel cord stretch

  1. Stand facing a wall.
  2. Lean forward and place the hands on the wall around shoulder height.
  3. Step forward with one foot.
  4. With both heels on the ground and a straight back, push your hips toward the wall until you feel a stretch in the back calf.
  5. Hold for 30 seconds, then relax for 30 seconds.
  6. Repeat.

Towel stretch

  1. Sit on the floor with both legs out in front.
  2. Loop a towel around one foot, holding both ends.
  3. Gently pull on the towel, pulling the ball of the foot toward the body. There should be a gentle stretch in the calf muscle.
  4. Hold for 30 seconds and relax for 30 seconds.
  5. Repeat three times.

Haglund’s deformity can cause symptoms that range from mild to severe. They include:

  • pain and swelling in the back of the heel
  • a visible bump on the back of the heel
  • calluses or blisters where the bump rubs against shoes

Pictures

A doctor may identify Haglund’s deformity by looking at the heel and discussing a person’s symptoms.

They may also use diagnostic tests, such as an X-ray, MRI, or ultrasound, to evaluate the shape of the heel bone and determine the severity of the condition.

In 2015, some researchers found that, in X-ray images, the angle between the sole of the foot and the base of the heel bone tended to be greater in people with Haglund’s deformity. They also noted that a change in position in the heel bone can put extra strain on the Achilles tendon, which could further increase the risk of bursitis and tendinitis.

Imaging tests can help a doctor decide which treatment and follow-up options will be most suitable.

Both Haglund’s deformity and heel spurs can cause pain in the back of the foot, but they are not the same.

  • Haglund’s deformity involves a bony lump at the back of the heel, which is often visible. It appears above where the Achilles tendon attaches to the bone. It does not always involve calcifications, but these can result if Haglund’s deformity leads to chronic inflammation.
  • A plantar heel spur is a bony lump that can develop on the bottom of the foot.
  • A posterior heel spur can appear where the Achilles tendon meets the bone. It may be visible, and calcifications can develop here.

Haglund’s deformity can affect the Achilles tendon by pushing on it, but a posterior heel spur can grow into the tendon, which may develop calcifications. People with a posterior heel spur may find it difficult to find comfortable footwear.

According to the American Academy of Orthopedic Surgeons (AAOS), heel spurs are unlikely to cause pain. Around 10% of individuals have heel spurs, but only 5% of them experience pain, say the AAOS.

Doctors do not know precisely why Haglund’s deformity occurs, but experts have linked it to several factors.

A person’s natural foot structure may sometimes make them more prone to the condition.

Healthcare professionals have linked some features to Haglund’s deformity, including:

  • a prominent heel bone that slopes outward, making shoes more likely to rub
  • feet that roll outward when walking, known as supination
  • a tight Achilles tendon, which may put pressure on the heel bone.
  • a high arch, which can force the heel slightly backward during walking and rub the Achilles tendon

People with the foot types listed above may wish to avoid shoes with rigid backs and ensure their footwear fits properly. Shoes or boots with rigid backs can cause friction that aggravates a foot structure that is prone to Haglund’s deformity. They can also exacerbate inflammation or trigger symptoms such as pain.

The shoes that experts have most often linked to Haglund’s deformity symptoms include:

  • ice skates and roller skates
  • hard-backed shoes, such as dress shoes
  • steel-toed work boots
  • stiff winter boots or rain boots

When a Haglund’s deformity develops, it will not go away without treatment. However, if symptoms are mild, the condition will not necessarily cause constant pain, and lifestyle measures can help manage it.

However, the bone lump will not shrink. Only surgery will remove the additional once it develops.

People cannot avoid Haglund’s deformity in every case. However, they may be able to reduce the risk of it developing with the following steps:

  • Wearing shoes that have open backs. The American Podiatric Medical Association cautions against open-backed shoes if a person has tendinitis, bunions, or other foot problems.
  • Wearing shoes with soft, flexible backs to prevent pressure on the heel.
  • Stretching correctly before and after exercise, especially the calves, Achilles tendon, and feet.
  • Wearing shoes that have proper arch support for people with high arches.
  • Taking a gradual approach to strenuous exercises, such as running, to avoid overuse injuries.
  • Speaking with a medical professional right away for heel pain. Haglund’s deformity may worsen over time without treatment.

Haglund’s deformity may be due to a genetic foot structure that people inherit at birth. Limiting the use of footwear that causes friction on the heel, however, may help prevent its development. It can also help manage any discomfort if it occurs.

Noninvasive therapies often help relieve pain in mild cases. If pain and other symptoms are severe, surgery can correct the underlying issue and provide relief.

People should not ignore foot pain. Finding a qualified health professional who treats foot pain is key to managing discomfort and may help prevent other aspects of Haglund’s syndrome, such as bursitis.