Haglund’s deformity is a bony bump on the back of the heel, where the Achilles tendon attaches.
The bump itself doesn’t go away without surgery, but the PAIN usually does, once you stop the shoe pressing on it and load the tendon the right way.
Most people get better with three changes:
- shoes with a soft or open back,
- a small heel lift, and
- calf exercises done on FLAT ground, not hanging off a step.
Expect it to take a few months.
Surgery is kept for pain that hasn’t settled after several months of proper treatment, and full recovery from it takes about a year.
What’s going on at the back of your heel
It’s often called a “pump bump”, because stiff-backed shoes like pumps rub right on it. Three things tend to happen in the same small spot, and they feed each other.
- The bump (Haglund’s deformity): an enlarged corner of bone at the top back of the heel bone. You can often see and feel it
- The bursa (retrocalcaneal bursitis): a small fluid-filled cushion sits between the tendon and the heel bone. The bump squeezes it, and it swells and hurts
- The tendon (insertional Achilles tendinopathy): the lowest part of the Achilles, where it joins the bone, gets overloaded and sore. Bone spurs can form there too
This is different from pain a few inches higher up the tendon, which is covered in Achilles tendinitis. The two are treated differently, so it’s worth knowing which one you have.
Signs it’s this
- A visible bump on the back of the heel, sometimes red or swollen
- Pain right where the tendon meets the bone, not higher up
- Worse in shoes with a stiff back, and often better barefoot or in open-backed shoes
- Stiff and sore first thing in the morning or after sitting
- Worse walking uphill, squatting or lunging, when the ankle bends up further
- More likely if: you have a high arch, tight calves or a family history of it, or you wear tight, stiff-backed shoes. Women and runners get it more often
What helps
- Take the pressure off the back: open-backed shoes, or shoes with a soft heel counter that doesn’t dig in
- A small heel lift: a lift in both shoes takes some strain off the tendon. Use one in each shoe so you don’t walk unevenly
- Padding: a soft gel or foam pad around the bump can stop the shoe rubbing on it
- Ice and pain relief: ice wrapped in a towel for up to 20 minutes eases a flare. Anti-inflammatory tablets such as ibuprofen can help for a short spell, if they suit you
- Keep moving: cycling and swimming usually keep you fit without pressing on the heel. Cut back hills and speed work for now
- Shockwave therapy: sometimes offered when months of exercise and shoe changes haven’t worked. It’s an extra, not a replacement
Exercise on flat ground, not off a step
When the ankle bends up a long way, the bottom of the tendon gets pressed against the bump and the bursa. Dropping your heel below a step does exactly that. The American Academy of Orthopaedic Surgeons advises that heel drop exercises are for pain higher up the tendon, not at the heel bone.
- Start with holds: rise onto your toes on both feet, on the floor, and hold for 30 to 45 seconds. Repeat a few times
- Then slow heel raises on the floor: up over about three seconds, down over about three seconds, stopping when your heel touches the ground
- Progress to one leg, then add weight with a backpack as it gets easy
- Go easy on deep calf stretches: a strong stretch bends the ankle up and presses the tendon against the bump. Gentle stretching is fine, but if it makes the heel worse the next morning, drop it
- Judge it by the next morning: a little discomfort during the exercise is fine. If the heel is worse the next day, cut back for a few days, don’t stop
The bump stays. The pain goes when the shoe stops pressing on it and the tendon gets stronger.
A word on cortisone
Cortisone injected into the Achilles can weaken the tendon and make it tear, so injections into this area are approached with real caution. If one is suggested, ask exactly where it’s going and why. See cortisone shot side effects.
When surgery is an option
Surgery is considered when pain is still limiting you after several months of shoe changes, heel lifts and exercise. The surgeon shaves off the bump, removes the inflamed bursa and any damaged tendon, and reattaches the tendon if needed. Tight calves are sometimes released at the same time.
- First 2 to 3 weeks: usually a cast or splint
- Next 2 months or so: a walking boot with heel wedges that are lowered over time
- Around 3 months: back in normal shoes for most people
- 6 to 8 months: return to running and high-impact sport
- About a year: full recovery
- Results: roughly 3 in 4 people are happy with the outcome. Risks include wound healing problems, nerve irritation and infection
Your surgeon may use a different timeline. Use theirs. Cleveland Clinic has a clear overview of Haglund’s deformity and its treatment.
Get seen today if
- You felt a sudden kick or heard a pop at the back of the ankle
- You can’t rise onto your toes on that leg, or you’re suddenly walking flat-footed
- The heel is red, hot and very swollen, or you have a fever
- You have diabetes or poor circulation and the shoe has rubbed a blister or open sore on the heel
A pop and weakness point to a tendon rupture. See Achilles rupture recovery.
Get it checked if
- The pain is getting worse despite changing your shoes
- Both heels hurt along with other swollen or stiff joints
- Pain started soon after an antibiotic from the “floxacin” family, such as ciprofloxacin. Tell the prescriber
- There’s no real progress after three months of the right shoes and exercises
- The pain is under the heel, worst with your first steps. That’s more likely plantar fasciitis
Surgery removes the bump. Better shoes and flat-ground loading remove the pain for most people.