An Overview of Haglund's Deformity

A painful bump on the back of your heel

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Haglund's deformity is a seldom-heard term for a bony bump on the back of the heel bone, where your Achilles tendon attaches to your heel. The bump is often red and irritated and flares up on occasion, causing pain and swelling.

The bump is usually due to an abnormality in foot function or bone position that creates shoe friction around the natural bony prominence at the back of the heel. Genetics may also predispose you to the condition. Constant friction at the back of the heel can also irritate skin, causing changes such as redness, thickening, and increased skin lines.

Haglund's deformity was described in 1927 by Patrick Haglund. It's also known as retrocalcaneal exostosis, Mulholland deformity, and "pump bump," because it often occurs in women and is aggravated by certain shoes, including pumps and other high heels.

Haglund's Deformity

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What Is Haglund's Deformity?

Haglund's deformity is relatively common but not very well understood. It's most common in middle age, more often seen in women than in men, and usually appears on both feet rather than just one. This condition is sometimes mistaken for other causes of pain in the rear of the foot, including:

Symptoms of Haglund's Deformity

The primary symptoms of Haglund's deformity are:

  • A noticeable bump on the back of the heel
  • Pain
  • Swelling
  • Redness
  • Blisters and/or callouses on and around the bump due to increased friction from shoes

Causes

Along with genetics and a potentially misshapen bone, Haglund's deformity is believed to be caused by:

  • High arches
  • A tight Achilles tendon
  • Walking on the outside of your feet
  • In runners, over-training
  • Tight or poor-fitting shoes
  • Abnormal foot biomechanics due to joint misalignment

The type of shoes you wear can influence whether you develop Haglund's deformity, too. Those most often linked to this problem have a stiff back and include:

  • Ice skates
  • Men's dress shoes
  • Women's pumps
  • Work boots

Diagnosis

A healthcare provider who's knowledgeable about foot problems can diagnose Haglund's deformity based on a physical examination and X-rays. If the healthcare provider isn't sure about the diagnosis at that point, they may order a magnetic resonance imaging (MRI) scan, as well.

You may start by seeing your primary healthcare provider, who might refer you to a podiatrist or foot and ankle specialist.

Treatment

When a pump bump becomes inflamed, the most important part of treatment is to reduce pressure and friction at the site of the bump. The best way to do this is to ensure that you are wearing a shoe that fits well and offers adequate support. Usually, shoes that are a bad fit are to blame. 

An array of conservative treatments are aimed at reducing pressure, pain, and inflammation. However, they don't shrink the bony protrusion itself. Conservative treatments include:

If these approaches don't alleviate your pain enough, you may need to have surgery.

Complications

When the bony lump of Haglund's deformity rubs against shoes, it can cause other nearby tissues to become inflamed. That can lead to complications, including:

  • Bursitis: Inflammation of a fluid-filled sac (bursa) that cushions a tendon against bone causes swelling and tenderness.
  • Achilles tendonitis: Symptoms of Achilles tendonitis, such as pain and swelling, usually occur a few centimeters above the area where the tendon attaches to the back of the heel.

Over time, chronic injury to the Achilles tendon can cause it to weaken and break down, a condition known as tendinosis.

Frequently Asked Questions

What is the painful bump on the back of my heel?

If it's a hard bump at the base of the Achilles tendon that gets worse when you wear stiff-backed shoes, it may be Haglund's deformity.

Can you get rid of a Haglund's deformity bump?

You can lessen the inflammation of the Haglund's deformity bump, which may help it appear smaller, but you can only get rid of the bump entirely with surgery. Fortunately, surgery isn't necessary in most cases.

Does Haglund's deformity go away?

The bony protrusion itself won't just go away—that requires surgery—but you can minimize the lump and the pain and irritation it causes via many conservative treatment options. These can range from ice and stretching to orthotics and physical therapy.

How long is recovery from Haglund's deformity?

Recovery time depends on the severity of the bump and what kind of treatment you receive. If surgery is necessary, you should expect to have a non-weight bearing cast on, meaning you can't walk, for about three weeks. After that, you'll likely have a walking cast or boot and start physical therapy. It may be between three and six months after surgery before you can wear high heels again.

A Word From Verywell

Haglund's syndrome can lead to significant pain and difficulty walking, but numerous treatments are available to relieve that pain and, hopefully, keep it from coming back. If you notice a hard, painful lump on the back of your heel, don't wait—bring it up with your healthcare provider before it gets worse and puts you at risk for complications. The earlier it's caught, the better chance you have of needing only conservative treatments to restore your function and get rid of the pain.

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  1. American College of Foot and Ankle Surgeons. Haglund's deformity.

  2. American Podiatric Medical Association. Haglund's deformity.

  3. Pękala PA, Henry BM, Pękala JR, Piska K, Tomaszewski KA. The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study [published correction appears in Bone Joint Res. 2019 Oct 3;8(9):437]. Bone Joint Res. 2017;6(7):446–451. doi:10.1302/2046-3758.67.BJR-2016-0340.R1

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