Haglunds deformity is an anatomic variation in which the back of the heel bone is larger than normal. Generally there is nothing wrong with that except that pressure from the shoes can be painful.

Haglund’s deformity, sometimes nicknamed the “pump bump,” is a bony enlargement that develops on the back of the heel, right where the Achilles tendon attaches to the heel bone (calcaneus). It gets its nickname because it often affects people who wear stiff, high-backed shoes—like pumps or certain dress shoes—that constantly rub against the heel. That repetitive pressure and friction can irritate the area, causing inflammation, swelling, and sometimes blistering or redness over the bony bump. It’s not just limited to fashionable footwear, though—any tight or poorly fitting shoe can contribute.

So what causes Haglund’s deformity in the first place? It’s often a combination of factors. Some people are just anatomically more prone to it—like those with a high arch, a tight Achilles tendon, or a naturally prominent heel bone. These structural factors put more pressure on the back of the heel when walking or running, especially if combined with the wrong type of footwear. Over time, that repeated stress can lead to bone growth and soft tissue irritation, particularly in the bursa—a fluid-filled sac that cushions the tendon. When this bursa gets inflamed, it’s called retrocalcaneal bursitis, and it makes the whole area painful and swollen.

Symptoms typically include a noticeable bump on the back of the heel, pain where the Achilles tendon attaches, and swelling or redness around the area—especially after wearing shoes that aggravate it. The pain often worsens with activity, particularly walking uphill or climbing stairs, and can make certain shoes impossible to wear comfortably. If the tendon gets involved due to chronic friction or inflammation, it can lead to Achilles tendinopathy, which adds even more discomfort and stiffness.

Treatment usually starts conservatively: switching to softer, open-backed shoes, applying ice to reduce inflammation, using heel pads or orthotics to relieve pressure, and stretching the Achilles tendon to loosen it. Anti-inflammatory meds (like ibuprofen) can help, too. If conservative methods don’t bring relief, especially if there’s significant pain or tendon involvement, a doctor might recommend physical therapy, cortisone injections (though cautiously around the tendon), or in more persistent cases, surgery to remove the excess bone and inflamed tissue. The key to managing Haglund’s deformity is early recognition and adjusting footwear and activity to prevent long-term complications.

Most Useful Resources:
Haglunds Deformity (Foot Health Forum)
The Haglunds deformity or ‘Pump Bump’ (Foot Health Friday)
Haglunds in an elite marathon runner (Podiatry Arena)
The Pump Bump (Podiatry Ninja)
Haglunds Deformity (Best Running Shoe)