Haglund's Deformity

Haglund's deformity is a bony enlargement of the posterior-superior aspect of the calcaneus — the back upper edge of the heel bone — where the Achilles tendon inserts. It is colloquially known as 'pump bump' because of its association with rigid-backed footwear, particularly women's pumps and dress shoes that place direct pressure on this area.

The condition is distinct from the plantar heel spurs most commonly associated with plantar fasciitis. Plantar heel spurs form on the underside of the heel where the plantar fascia attaches and are associated with bottom-of-heel pain. Haglund's deformity involves the back of the heel and the Achilles tendon — a completely different anatomical location with different associated structures, different symptoms, and different treatment considerations.

Haglund's deformity produces pain at the back of the heel — specifically where the shoe heel counter contacts the bony prominence. The friction and pressure from rigid footwear irritates the soft tissue overlying the prominence, and the retrocalcaneal bursa — a fluid-filled sac between the Achilles tendon and the heel bone — becomes inflamed. Over time, ongoing irritation can also lead to Achilles tendon involvement at its insertion.

The condition tends to affect people with a high arch foot type, a tight Achilles tendon, and those who regularly wear rigid-backed footwear. Athletes in cleated or stiff-heeled footwear are also at elevated risk. The deformity itself — the bony enlargement — is structural and cannot be reversed by non-surgical means, but symptoms can often be managed effectively without surgery through appropriate footwear modification and soft tissue management.

Dr. Gunter evaluates the full clinical picture — the size of the prominence, the degree of bursal and Achilles tendon involvement, the patient's foot structure and footwear demands — before recommending the appropriate management approach.