Haglund’s deformity is a relatively common yet often misunderstood condition affecting the posterior aspect of the heel. Characterized by a bony enlargement on the back of the calcaneus—the heel bone—this deformity can lead to significant discomfort, impaired mobility, and chronic irritation of surrounding soft tissues. Although it is sometimes dismissed as a minor foot issue, Haglund’s deformity can meaningfully impact quality of life, especially for individuals whose footwear or biomechanics exacerbate the condition. Understanding its causes, symptoms, diagnostic process, and treatment options is essential for both clinicians and patients seeking relief.

Definition and Anatomical Basis

Haglund’s deformity is defined as a bony growth or enlargement on the posterosuperior aspect of the calcaneus, precisely where the Achilles tendon inserts. This prominence creates a visible and palpable bump on the back of the heel. Because of its association with irritation from rigid-backed shoes—particularly women’s pumps—it is colloquially known as a “pump bump”.

The deformity itself is not inherently pathological; rather, the problems arise when the enlarged bone rubs against surrounding soft tissues. This friction can inflame the retrocalcaneal bursa, a fluid-filled sac that cushions the Achilles tendon, leading to retrocalcaneal bursitis. In some cases, the tendon itself becomes irritated, contributing to Achilles tendinopathy.

Etiology: Why Haglund’s Deformity Develops

The development of Haglund’s deformity is multifactorial. Genetics play a notable role: individuals with certain foot shapes—such as high arches (pes cavus)—are more prone to developing the condition because their heel bone tilts in a way that increases pressure on the posterior calcaneus. Similarly, a tight Achilles tendon can pull excessively on the heel bone, contributing to the formation of the bony prominence.

Footwear is another major contributor. Shoes with rigid backs, such as pumps, dress shoes, or steel?toed boots, can repeatedly irritate the heel, accelerating inflammation and bone growth over time. This is why the condition is often seen in individuals who frequently wear such footwear for occupational or stylistic reasons.

Biomechanical factors also play a role. Gait abnormalities, overpronation or supination, and repetitive stress from activities like running can all increase friction at the back of the heel. In many cases, Haglund’s deformity develops quietly and asymptomatically until a triggering factor—such as a change in footwear or activity level—causes irritation and pain.

Clinical Presentation: Symptoms and Associated Conditions

The hallmark symptom of Haglund’s deformity is pain at the back of the heel, particularly where the shoe contacts the bony bump. Patients often report:

• A visible, firm bump on the posterior heel
• Swelling or redness around the area
• Pain that worsens with walking, running, or wearing tight shoes
• Tenderness when the heel is pressed

Because the deformity irritates surrounding tissues, it is commonly associated with other conditions. Retrocalcaneal bursitis is one of the most frequent complications, resulting from inflammation of the bursa between the Achilles tendon and the heel bone. Achilles tendonitis or tendinopathy may also occur due to chronic friction and strain.

In severe or long?standing cases, the combination of bone enlargement, tendon irritation, and bursal inflammation is referred to as Haglund’s syndrome. While Haglund’s deformity refers specifically to the bony prominence, Haglund’s syndrome encompasses the broader constellation of symptoms and soft?tissue involvement.

Diagnosis

Diagnosis typically begins with a clinical examination. A healthcare provider will assess the heel for swelling, tenderness, and the characteristic bony bump. They may also evaluate foot structure, gait, and Achilles tendon flexibility.

Imaging plays a crucial role in confirming the diagnosis. X?rays can clearly show the bony enlargement on the calcaneus and help differentiate Haglund’s deformity from other causes of posterior heel pain. In some cases, ultrasound or MRI may be used to evaluate soft?tissue involvement, such as bursitis or tendon degeneration.

Treatment Options

Treatment for Haglund’s deformity ranges from conservative measures to surgical intervention, depending on severity and response to initial therapies.

Conservative Management

Most patients begin with non?surgical treatments aimed at reducing inflammation and minimizing friction. These may include:

• Footwear modification: Switching to shoes with soft backs or open heels can significantly reduce irritation.
• Heel lifts or orthotics: These can alter foot mechanics and reduce pressure on the Achilles tendon.
• Ice and anti?inflammatory measures: Applying ice and using non?prescription anti?inflammatory medications can help manage pain and swelling.
• Physical therapy: Stretching the Achilles tendon and strengthening surrounding muscles can improve biomechanics and reduce strain.
• Padding: Heel pads or moleskin can create a buffer between the shoe and the heel.

These approaches often provide meaningful relief, especially when the deformity is mild or symptoms are recent.

Surgical Intervention

When conservative treatments fail, surgery may be considered. The goal of surgery is to remove the bony prominence and address any associated soft?tissue issues. Procedures may include:

• Resection of the bony enlargement
• Debridement of inflamed bursa
• Repair of damaged Achilles tendon fibers

Surgical outcomes are generally positive, but recovery can be lengthy due to the involvement of the Achilles tendon.

Prognosis and Prevention

With proper management, most individuals with Haglund’s deformity can achieve significant symptom relief. Conservative treatments are often effective, and even when surgery is required, long?term outcomes are typically favorable.

Prevention focuses on reducing heel irritation and maintaining healthy foot mechanics. Strategies include:

• Wearing shoes with soft or open backs
• Stretching the Achilles tendon regularly
• Avoiding prolonged use of high heels or rigid?backed footwear
• Using orthotics if foot structure predisposes to the condition

By addressing these factors, individuals can reduce the likelihood of developing symptoms or prevent recurrence after treatment.

Haglund’s deformity is more than just a bump on the heel—it is a biomechanical and anatomical condition that can significantly affect comfort and mobility. Rooted in a combination of genetic, structural, and lifestyle factors, it often presents with pain, swelling, and irritation due to friction between the bony prominence and surrounding soft tissues. Fortunately, with a clear understanding of its causes and treatment options, most individuals can manage the condition effectively. Whether through footwear changes, physical therapy, or surgical correction, relief is achievable, allowing patients to return to daily activities without persistent heel pain.