Do you have a hard bump on the back of your heel that gets sore and red whenever certain shoes rub it? That bump may be Haglund's deformity. It is a bony enlargement on the back of the heel bone, right where the Achilles tendon attaches.1,2 People often call it a "pump bump," because stiff-backed high heels (pumps) are known to irritate it.1,2

Here's what it is, why it flares up, what may help at home and when it's worth having a podiatrist take a look.

When heel pain is urgent: Cleveland Clinic advises going to an emergency room if you suddenly can't move your foot, have severe pain, or think you may have broken a bone after an injury.2 For urgent foot concerns, call us instead of using the web form: Butte & Anaconda (406) 782-2278, Bozeman, Ennis & Harlowton (406) 587-8478.

What Is Haglund's Deformity?

Haglund's deformity is a bony growth on the heel bone (calcaneus). You can often see it and feel it as a firm bump at the back of the heel.2 It was first described by Patrick Haglund in 1927, and it also goes by other names, such as retrocalcaneal exostosis.4

The bump itself isn't usually the whole problem. When a shoe rubs it, the soft tissue near the Achilles tendon gets irritated. That often leads to bursitis.1 A bursa is a small, fluid-filled sac that cushions the space between a tendon and a bone.1 The one behind the heel, under the Achilles tendon, is called the retrocalcaneal bursa.3 Ongoing pressure can also lead to Achilles tendinitis.2

Doctors sometimes use the term "Haglund's syndrome" when the bump comes with this kind of irritation: an inflamed bursa and a thickened, inflamed Achilles tendon.4

What Does a Pump Bump Feel Like?

Common signs include:

  • A noticeable bump on the back of the heel1,2
  • Pain where the Achilles tendon attaches to the heel1
  • Swelling at the back of the heel1,2
  • Redness or other skin discoloration around the bump1,2
  • Pain that is often worse when you start walking after resting4

It often shows up on both feet.2,4 A review in the journal Cureus notes it most often affects middle-aged adults, and women more often than men.4

Pain at the back of the heel can have other causes, including insertional Achilles problems, bursitis on its own and conditions like gout or inflammatory arthritis.3,4 That's one reason a proper exam matters. Our pages on heel pain and Achilles tendinitis cover some of the look-alikes.

Why Do Some People Get It?

The exact cause isn't known, and it may run in families.2 Shoes with stiff, rigid backs are the classic trigger. ACFAS lists pumps, ice skates and men's dress shoes as examples.1 Here in Montana, that list is a good reminder to check how skates and stiff-backed boots press on your heels this winter.

Factors linked to Haglund's deformity include:

  • A high arch1,2,4
  • A tight Achilles tendon1,2,4
  • A tendency to walk on the outside of the heel1
  • Tight or narrow shoes2,4
  • Heavy use of the heel, as in running2,4
  • A family history of the condition2

How Is It Diagnosed?

A foot and ankle specialist will ask about your symptoms and examine your heel.1,2 X-rays are commonly used to look at the shape of the heel bone and rule out other problems.1,2 An MRI may be used in unclear cases or when surgery is being considered.2,4

What Can I Do at Home?

Nonsurgical care aims to calm the irritated tissue around the bump. It won't make the bony bump itself go away.1 Options that sources describe include:

  • Change your shoes. Shoes with soft backs, or backless shoes, take pressure off the bump.1 Avoid stiff heel backs that press on the area.2
  • Heel lifts or pads. Heel lifts and heel pads are commonly suggested.1 The Cureus review notes heel lifts may be especially useful for people with high arches.4
  • Ice. Ice the swollen area with a thin towel between the ice and your skin.1
  • Over-the-counter anti-inflammatory medicine. Medicines like ibuprofen may ease pain and swelling.1,2 Check with your doctor or pharmacist first if you have other health conditions or take other medicines.
  • Stretching. Stretches for the Achilles tendon can ease tension on the back of the heel.1
  • Ease off painful activities. MedlinePlus advises avoiding activities that cause pain when the bursa behind the heel is inflamed.3

Cleveland Clinic notes that conservative care is often enough to manage symptoms.2 For heel bursitis, MedlinePlus says most cases improve within several weeks with proper treatment.3

When Should I See a Podiatrist?

Cleveland Clinic suggests seeing a provider if your heel pain gets worse or lasts more than a few weeks, if you have trouble standing or walking, or if you have swelling.2 MedlinePlus advises getting care if heel pain doesn't improve with rest.3

A podiatrist can confirm what's causing the pain and talk with you about options. Depending on your situation, these may include physical therapy, custom orthotics or, in some cases, a cast to rest the area.1,4 When symptoms don't settle with nonsurgical care, surgery to remove the excess bone and inflamed tissue may be considered.1,2,4 Cleveland Clinic describes surgery as rare and reserved for severe cases, and notes that recovery usually takes a few months.2 Whether any treatment is right for you is something to discuss with your own provider.

Can I Prevent a Pump Bump From Flaring Up?

Because the cause isn't fully understood, it can't always be prevented.2 But these habits may help keep the area calm:

  • Choose comfortable, supportive shoes without stiff backs that press on the heel1,2
  • Use arch supports or orthotics if they help your feet1
  • Stretch your Achilles tendon regularly1,3
  • Avoid running on hard surfaces or uphill1
  • Warm up before exercise and stop when something hurts2

For more on finding shoes that work with your feet, see our article on proper footwear.

The Bottom Line

Haglund's deformity is a bony bump on the back of the heel. It tends to hurt when stiff-backed shoes rub it and irritate the tissue around the Achilles tendon. Softer-backed shoes, heel pads or lifts, ice and stretching may help calm a flare, though they won't shrink the bump. If the pain keeps coming back, lasts more than a few weeks or makes walking hard, have it checked.

If the back of your heel is making shoes miserable, our podiatrists can help. Request an appointment and our team will follow up within one business day. You can also find your nearest office on our locations page.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

  1. Haglund's Deformity. American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
  2. Haglund's Deformity: Causes, Symptoms & Treatment. Cleveland Clinic. my.clevelandclinic.org
  3. Bursitis of the Heel. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
  4. Vaishya R, Agarwal AK, Azizi AT, Vijay V. Haglund's Syndrome: A Commonly Seen Mysterious Condition. Cureus. 2016;8(10):e820. pmc.ncbi.nlm.nih.gov