Haglund’s Deformity (Pump Bump): Causes & Non-Surgical Treatment | Michigan Podiatrist

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Haglund’s deformity — also called “pump bump” — is a bony enlargement at the back of the heel bone (calcaneus) where the Achilles tendon attaches. It’s one of the most commonly misdiagnosed causes of posterior heel pain, and one we treat regularly at Balance Foot & Ankle.

What Is Haglund’s Deformity?

The posterior superior corner of the calcaneus becomes enlarged in Haglund’s deformity, creating a prominent bony bump. As the heel bone prominence rubs against the back of rigid-heeled footwear (particularly pumps/dress shoes, which is why it’s called “pump bump”), the soft tissues between the bone and the Achilles tendon become irritated. This leads to retrocalcaneal bursitis (inflammation of the bursa between the Achilles and the heel bone), insertional Achilles tendinopathy, or both.

Causes and Risk Factors

• High-arched foot (cavus foot): A high arch increases the angle of the calcaneus, pushing the posterior prominence toward footwear — the most significant structural risk factor
• Tight Achilles tendon: Reduces flexibility and increases tension on the posterior heel
• Rigid-heeled footwear: Rigid heel counters directly impinge on the bony prominence
• Genetic predisposition: Some families have characteristic heel bone shape
• Running gait patterns: Heavy heel strikers may develop more irritation

Symptoms

• A visible, palpable bump on the back of the heel
• Pain at the back of the heel, specifically at the bone-Achilles tendon junction
• Swelling and redness at the back of the heel
• Pain that worsens with firm-heeled footwear and improves with sandals or barefoot
• Occasionally, skin blistering or callus directly over the prominence

Distinguishing from Achilles Tendinopathy

Haglund’s typically causes pain at the insertion of the Achilles (where it meets the heel bone) vs. mid-substance Achilles tendinopathy which causes pain 2–6cm above the insertion. MRI or ultrasound can distinguish between the conditions and guide treatment. Many patients have both.

Conservative Treatment

Footwear Modifications

The immediate first step: eliminate rigid heel counters by wearing soft-backed shoes, open-backed shoes (clogs, mules), or using heel counter padding to soften the shoe-heel contact. This alone can provide significant relief in mild-moderate cases.

Heel Lifts and Custom Orthotics

Heel lifts elevate the heel, tilting the Achilles attachment downward and reducing contact with the back of the shoe. Custom orthotics correct the underlying high-arch foot structure and redistribute forces at the heel.

Physical Therapy

Eccentric calf strengthening (shown to improve insertional Achilles tendinopathy), Achilles stretching program, and manual therapy can reduce pain and improve function.

Ice and Anti-inflammatories

NSAIDs and icing provide symptomatic relief. Corticosteroid injections near the retrocalcaneal bursa (not into the Achilles tendon) can help acute flares but should be used judiciously.

Shockwave Therapy (ESWT)

For chronic cases with insertional tendinopathy, ESWT has good evidence and avoids the risks of surgery.

Surgical Treatment

When conservative care fails after 3–6 months, surgery (calcaneal exostectomy — removal of the prominence) is highly effective. The approach can be open or endoscopic. Recovery involves 4–6 weeks of protected weight-bearing. Outcomes are excellent for properly selected patients.

Pump Bump Causing Pain? We Have Non-Surgical Solutions.

Balance Foot & Ankle treats Haglund’s deformity at our Howell and Bloomfield Township, MI offices. Custom orthotics, shockwave therapy, and surgical options available.

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📞 (810) 206-1402

Related Resources

• Plantar Fasciitis Treatment
• Custom Orthotics for High-Arched Feet
• All Foot & Ankle Treatments

Get Relief from Haglund's Deformity in Michigan

Pump bump and posterior heel pain respond to both conservative and surgical approaches. Our podiatrists specialize in resolving this painful heel condition.

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Clinical References

1. Vaishya R, et al. Haglund syndrome: diagnosis and treatment using sonography. Cureus. 2016;8(10):e820.
2. Sofka CM, et al. Posterior heel pain: diagnosis with MRI and US. HSS J. 2006;2(1):27-29.
3. Pavlov H, et al. The Haglund syndrome: initial and differential diagnosis. Radiology. 1982;144(1):83-88.

Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care

Differential Diagnosis: What Else Could It Be?

Not every case of haglund’s deformity is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.

Condition	How It Differs
Retrocalcaneal bursitis alone	Anterior to the Achilles insertion, no posterior bone prominence.
Insertional Achilles tendinopathy	Pain at the tendon-bone junction; calcification may be present on X-ray.
Sever’s disease (pediatric)	Child or adolescent with growth-plate pain; Haglund presents in adults.

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