Haglund’s Deformity (Pump Bump): Treatment Without Surgery
Haglund’s deformity — also called “pump bump” — is a bony enlargement on the back of the heel where the Achilles tendon attaches, irritated by rubbing against shoe heel counters. Symptoms: painful, red, swollen bump on the back of the heel; pain worsens in dress shoes, ice skates, or pumps; sometimes confused with insertional Achilles tendinitis. Most common in women 20-40 from high-heeled shoes, but men get it from rigid work boots too.
In my Michigan podiatry clinic, ~85% of Haglund’s deformity patients improve without surgery: (1) backless shoes (mules, clogs) or shoes with soft heel counters, (2) silicone heel pad inside shoe to lift heel away from shoe back, (3) open-back work shoes, (4) NSAIDs and ice for flares, (5) physical therapy for stretching the Achilles. Surgery (Haglund resection) is reserved for failed 6 months of conservative care — ~80-90% success rate, 6-12 week CAM boot recovery.
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Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: How do you get rid of Haglund’s deformity?
What Is Haglund’s Deformity and Why Does It Hurt?
Haglund’s deformity is a bony enlargement of the posterosuperior calcaneus (the back-upper surface of the heel bone) that creates a prominent bump at the rear of the heel. Dubbed the ‘pump bump’ because of its association with women’s pump shoes (whose rigid heel counter applies repetitive pressure against the posterior heel), the deformity causes pain through two mechanisms: direct pressure and friction from footwear against the bony prominence; and irritation and bursitis of the retrocalcaneal bursa (the small fluid-filled sac between the posterior calcaneus and the Achilles tendon insertion).
The deformity’s exact cause is debated. Genetic predisposition to posterior calcaneal prominence is likely—families with Haglund’s are observed. High-arch (cavus) feet are at higher risk because the heel inverts during weight-bearing, forcing the posterior calcaneus to protrude more prominently. Tight Achilles tendons create greater compressive force between the tendon and the calcaneal prominence, worsening bursitis.
Clinical presentation: a visible, palpable bony bump at the back of the heel with associated redness and swelling over the prominence; pain when the heel counter of footwear presses against the bump; pain with Achilles tendon loading activities (walking, running, stair climbing); and sometimes crepitus (grinding) from retrocalcaneal bursitis. Distinguished from insertional Achilles tendinopathy (which is directly at the Achilles insertion) by the location of the bony prominence slightly superior to the tendon insertion.
Conservative Treatment Options
Footwear modification is the most important conservative intervention: (1) Eliminate or avoid any footwear with a rigid heel counter that contacts the Haglund’s prominence—the most common culprit being women’s pump shoes and rigid-counter athletic shoes; (2) Open-back footwear (sandals, shoes without heel counters) eliminates the primary irritation source; (3) Heel padding within shoes (donut-shaped padding with the center over the bony prominence) reduces direct pressure; and (4) A small heel lift (¼ to ½ inch) raises the heel within the shoe, changing the contact point of the heel counter relative to the bony prominence.
Physical therapy for Haglund’s: Achilles stretching reduces the compressive force on the retrocalcaneal bursa; eccentric calf exercises for associated Achilles tendinopathy component; and ultrasound or cold laser therapy over the retrocalcaneal bursa to reduce inflammation.
Retrocalcaneal bursa injection: cortisone injection into the retrocalcaneal bursa (under ultrasound guidance for accuracy and to avoid intratendinous injection) provides significant pain relief for 2–6 months. Limits: cortisone injection should not be given into the Achilles tendon itself—the bursa injection is done between the calcaneus and the tendon.
Surgical Options for Refractory Haglund’s
Surgical management is appropriate for Haglund’s deformity that fails 3–6 months of appropriate conservative care. Two surgical approaches: (1) Open or arthroscopic posterosuperior calcaneal osteotomy—removing the bony prominence; either open through a direct posterior incision or endoscopically through two small portal incisions. Endoscopic approach has similar outcomes to open surgery with faster recovery; (2) Calcaneal osteotomy (calcaneal slide)—for patients with associated high-arch mechanics, a closing wedge osteotomy can simultaneously reduce the prominence and correct the underlying mechanical predisposition.
Recovery: 4–6 weeks non-weight-bearing after bony resection, then gradual weight-bearing progression. Full shoe wear in 8–12 weeks. Return to sport 3–5 months. Results are generally good: 75–85% patient satisfaction with pain relief and return to footwear.
Simultaneous Achilles tendon debridement is performed if insertional Achilles pathology is present—MRI pre-operatively identifies the degree of tendon involvement at the calcaneal insertion to guide surgical planning.
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✅ Pros / Benefits
- Conservative care (footwear modification, heel padding) resolves most Haglund’s symptoms without surgery
- Surgical resection has good outcomes when conservative treatment fails
❌ Cons / Risks
- Footwear restrictions can be significant—open-back shoes are not always appropriate for all settings
Dr. Tom Biernacki’s Recommendation
Haglund’s deformity is one of the most footwear-sensitive conditions in podiatry. The patient who comes in with a painful pump bump—the first and most important question is always: what shoes are you wearing? Open-backed shoes or a soft heel counter often resolves symptoms completely without any other intervention. For patients who need closed-back shoes (workplace requirements, etc.), a donut pad and heel lift get most of them through. Surgery is reserved for the minority who can’t manage with conservative measures.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Can Haglund’s deformity go away on its own?
The bony prominence doesn’t resolve on its own, but the associated bursitis and pain can resolve with appropriate footwear modification and conservative treatment.
Is Haglund’s deformity the same as Achilles tendinopathy?
They often coexist. Haglund’s is a bony prominence of the posterior calcaneus; insertional Achilles tendinopathy is degeneration of the tendon at its calcaneal attachment. Both can be treated simultaneously surgically when present together.
How do I know if I need surgery for Haglund’s?
Surgery is considered after 3-6 months of appropriate conservative care (footwear modification, heel padding, physical therapy, cortisone injection) without adequate pain relief.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)