Have you noticed a painful bump located in the back of your heel bone that becomes irritated with walking and in shoe gear?
You may be suffering from a Haglund’s deformity, also known as a “pump bump.” This condition can make everyday activities uncomfortable and can worsen over time without proper treatment. 
The Haglund’s deformity is a bony enlargement located on the back of the heel bone (calcaneus). This is also the location where the Achilles tendon attaches to the heel bone. The prominent bone can rub against the heel counter of shoes, causing irritation, inflammation, and pain. It is often referred to as a pump bump since it has been historically associated with wearing rigid-backed dress shoes or high heels.
The common symptoms of a Haglund’s deformity include pain at the back of the heel bone. There is associated swelling or redness at the site of the Achilles tendon insertion. The pain is usually associated with shoes that have a firm counter. The pain can increase with walking, running, or exercise. The patient can also develop a painful bursa, known as retrocalcaneal bursitis.
The Haglund’s deformity is usually associated with foot structure, such as people with high arches. This arch height can place increased pressure on the back of the heel bone. A tight Achilles tendon can increase stress and friction where the tendon attaches to the heel bone.
Improper footwear, such as shoes with stiff backs, dress shoes, high heels, and skates, can repeatedly irritate the area.
A podiatrist will perform a thorough clinical examination and discuss your symptoms and activity level. The physical examination will include evaluation of the heel bone and the Achilles tendon. A foot structure assessment and gait analysis will help determine the cause of the deformity. X-rays will aid in evaluating the heel bone. An MSK ultrasound will be helpful in evaluating Achilles tendon inflammation or retrocalcaneal bursitis.
Conservative treatment includes shoe modifications to reduce pressure on the heel bone. Heel lifts or orthotics can help address abnormal biomechanics of the foot. Patients are advised to avoid rigid-back shoes. Stretching exercises for the Achilles tendon and tight calf muscles may also be recommended. Anti-inflammatory medication and ice treatments help reduce swelling in the back of the heel bone. Fortunately, many patients respond well to conservative treatment when diagnosed early.
If conservative treatment fails and pain persists, surgery may be recommended. Surgical treatment typically involves removing the bony prominence and addressing any damage to the Achilles tendon.
If you are experiencing persistent pain or swelling at the back of your heel, early evaluation can help prevent the condition from worsening. Prompt treatment may allow you to avoid chronic inflammation and prolonged discomfort.
I am Dr. Joseph A. Cione, board-certified foot surgeon with Advanced Footcare, proudly serving patients in Woodbury, Baldwin, and Manhasset.
