Haglunds Deformity: Symptoms, Types, Causes and Treatment

Haglund’s deformity is more than just a “bump on the heel.” It’s a complex and often misunderstood condition that can cause persistent pain, limit mobility, and significantly impact daily life. In this article, we’ll explore Haglund’s deformity through its tell-tale symptoms, distinct types, underlying causes, and the full range of modern treatments—helping you understand both the problem and the evolving solutions.

Symptoms of Haglunds Deformity

Haglund’s deformity doesn’t sneak up quietly—it makes itself known through discomfort, visual changes, and activity-limiting pain. Recognizing the symptoms early is essential for effective management and prevention of complications.

Symptom	Description	Prevalence/Notes	Source(s)
Heel Pain	Aching or sharp pain on the back of the heel	Often worse after rest or activity	2 7 8 10
Swelling	Noticeable puffiness over the heel bump	May be persistent or worsen with shoes	1 2 8
Redness	Skin irritation or redness	Especially at the shoe contact area	2 7 8
Stiffness	Reduced ankle/heel flexibility	Often after periods of rest	2
Limp/Bruising	Difficulty walking, possible bruising	In more severe or acute cases	10
Visible Bump	Enlarged, hard prominence at the heel	Sometimes called “pump bump”	2 8 9

Table 1: Key Symptoms of Haglund's Deformity

Understanding the Symptoms

Heel Pain: The Hallmark Symptom

Pain at the back of the heel is the most common and consistent complaint. It often intensifies after rest (such as getting up in the morning) or following activity. This pain typically localizes where the Achilles tendon inserts into the heel bone (calcaneus) and may radiate up the tendon or into the foot 2 7 8 10.

Swelling and Redness

Many people notice swelling right above the heel, especially after wearing rigid or high-heeled shoes. The area can become red and sensitive, particularly when the bony prominence is irritated by shoe contact 1 2 8.

Stiffness and Limping

Stiffness, especially after periods of inactivity, can make movement uncomfortable. In more advanced cases, people may limp or avoid putting weight on the affected foot. Bruising is less common but can occur if there’s acute inflammation or associated tendon injury 2 10.

The “Pump Bump”

A visible, hard bump on the back of the heel—sometimes called a “pump bump”—is characteristic. This is the actual bony enlargement that defines Haglund’s deformity and is often the first thing people or clinicians notice 2 8 9.

Associated Conditions

Haglund’s deformity often doesn’t act alone. It can lead to or occur alongside:

• Retrocalcaneal bursitis: Inflammation of the bursa (fluid-filled sac) between the tendon and heel bone, causing further swelling and pain 1 2 7 8
• Achilles tendinitis/tendinopathy: Irritation or degeneration of the tendon itself 7 10 11
• Skin changes: Chronic rubbing may cause thickened skin or callus formation.

Types of Haglunds Deformity

Not all Haglund’s deformities look or behave the same. Recognizing the different types helps clinicians choose tailored treatments and helps patients understand their own prognosis.

Type	Description	Surgical Implications	Source(s)
Upper	Bump at the upper posterosuperior heel	Suited for endoscopic/minimally invasive surgery	5 14 15
Upper-Lateral	Prominence extends towards outside of heel	Sometimes treated endoscopically	5
Arc Type	Curved, arching bony prominence	Typically needs open procedure	5
Total	Extensive, covers large heel area	Open surgery recommended	5 14 15
Cosmetic	Mainly visible, little pain/impairment	Often managed conservatively	5
Hiding	Subtle or not externally visible, but affects function (athletes)	Challenging to diagnose/treat	5

Table 2: Types of Haglund’s Deformity

Clinical and Morphological Classifications

Clinical Types

• Common: The typical, symptomatic form with pain, swelling, and visible bump.
• Atypical: Unusual symptom patterns or presentation.
• Cosmetic: Deformity is mainly visual, with little to no discomfort.
• Hiding: Subtle cases, especially in athletes, where function is impaired even without overt swelling or pain 5.

Morphological Types

A recent review classifies Haglund’s deformity by its location and extent:

• Upper: The bump is located at the top, posterosuperior aspect of the calcaneus.
• Upper-Lateral: The prominence extends towards the outside (lateral aspect) of the heel.
• Arc Type: The exostosis arches along the posterior heel.
• Total: The enlargement encompasses much or all of the posterior calcaneus.
• Atypical Variations: Unusual shapes or locations 5 14.

Implications for Treatment

• Upper and Upper-Lateral Types: Often suitable for endoscopic or minimally invasive procedures, which offer quicker recovery and less soft tissue trauma 5 14 15.
• Arc Type and Total: Due to their size or complexity, open surgery is generally required for adequate correction 5 14.
• Cosmetic and Hiding Types: Conservative management is often sufficient, but hiding types require high clinical suspicion, especially in athletes experiencing unexplained performance drop 5.

Causes of Haglunds Deformity

While the hallmark bump is clear, the reasons behind its development are multifactorial—ranging from genetics to lifestyle choices and foot biomechanics.

Cause	Description	Notes/Associated Factors	Source(s)
Foot Structure	High arches (cavus foot), altered heel angles	Causes extra pressure on heel	2 3 7
Tight Achilles	Increased tension at insertion site	Promotes bone growth and impingement	2 7
Inherited Traits	Family history of similar foot shapes or issues	Genetic predisposition	2
Footwear	Rigid shoes, high heels (“pump” shoes)	Direct irritation of soft tissues	1 2
Overuse	Repetitive activities, sports	Microtrauma at tendon insertion	7 10
Age/Gender	Middle age, female predominance	Bilateral in many cases	2 3 7
Rare Causes	Osteochondroma, other bone tumors	Exceptionally rare	9

Table 3: Causes of Haglund’s Deformity

Biomechanical and Lifestyle Factors

Foot Structure

A high-arched (cavus) foot puts more pressure on the back of the heel, increasing the risk of developing the bony prominence. Altered calcaneal angles and verticalization of the heel bone also contribute by changing the way forces are distributed during walking or running 2 3 7.

Tight Achilles Tendon

A shortened or tight Achilles tendon pulls more forcefully on its insertion at the heel bone. Over time, this increased tension can promote bone growth (exostosis) and exacerbate impingement between the tendon and the bone 2 7.

Footwear and Activity

Wearing shoes with rigid backs or high heels—hence the term “pump bump”—repeatedly irritates the area, especially if the bony prominence is already forming. Athletes and people engaging in repetitive, high-impact activities are at higher risk due to continual microtrauma 1 2 7 10.

Genetic and Demographic Influences

• Heredity: Family history plays a role, as inherited foot shapes or biomechanical patterns can predispose certain individuals 2.
• Age and Gender: Middle-aged adults are most commonly affected, with a higher incidence in females. The deformity is often bilateral (both feet) 2 3 7.

Rare and Unusual Causes

In very rare cases, bone tumors such as osteochondroma can mimic or cause a massive Haglund’s deformity 9. Such cases require special clinical attention.

Treatment of Haglunds Deformity

Managing Haglund’s deformity is a stepwise process: most people improve with conservative treatments, but persistent or severe cases may require surgery. The choice of treatment depends on symptom severity, deformity type, and patient activity levels.

Treatment	Approach/Examples	Indications/Outcomes	Source(s)
Footwear Change	Soft backs, open-heeled, lower heels	First-line for symptom relief	1 2 8
Orthotics	Heel lifts, custom inserts	Offloads pressure, improves comfort	2 12
Medications	NSAIDs, analgesics	Reduces pain and inflammation	2 8
Physiotherapy	Stretching, strengthening, modalities	Improves flexibility, reduces pain	2 12
Immobilization	Temporary rest, braces	For acute or severe symptoms	1 12
Injections	Corticosteroids	Short-term relief (use with caution)	1 8
Surgery	Open or endoscopic bump removal, tendon repair, osteotomy	For refractory cases, tailored to type	1 5 11 12 13 14 15
Novel Techniques	Wedge osteotomy (Keck-Kelly), minimally invasive	Promising for select cases	13 14 15

Table 4: Treatment Options for Haglund’s Deformity

Conservative (Non-Surgical) Management

Footwear Modification

Switching to shoes with soft backs, open heels, or lower heels minimizes irritation and pressure on the bony prominence—often providing early symptom relief 1 2 8.

Orthotics and Heel Lifts

Custom shoe inserts or heel lifts can redistribute pressure and improve foot mechanics, helping to reduce pain and prevent progression 2 12.

Physiotherapy

Physical therapy targets tight calf muscles and Achilles tendon with stretching and strengthening exercises. Modalities such as ultrasound or ice may help control pain and inflammation 2 12.

Medications and Injections

Non-steroidal anti-inflammatory drugs (NSAIDs) and occasional corticosteroid injections can help manage pain and inflammation, though steroid injections near the Achilles tendon should be used with caution due to risk of tendon rupture 2 8.

Immobilization

Short-term immobilization, such as bracing or casting, may be used in severe cases to allow the area to settle 1 12.

Effectiveness

Most patients experience improvement with conservative measures. However, those with significant deformity, persistent symptoms, or functional limitations may require surgical intervention 1 2 12.

Surgical Options

Open Exostectomy

Traditional surgery involves removing the bony prominence via an open approach, with careful protection or repair of the Achilles tendon and associated bursae 1 11 12.

Endoscopic and Minimally Invasive Techniques

Advances in technology now allow for endoscopic resection of the bony deformity, bursectomy, and even tendon repair—leading to less soft tissue trauma and faster recovery in selected cases, particularly for “upper” and “upper-lateral” types 5 14 15.

Calcaneal Osteotomy (Keck and Kelly Technique)

A closing wedge osteotomy can decompress the posterior calcaneus without disturbing the Achilles tendon attachment. This is especially beneficial for younger, active patients and those with certain foot shapes 13 14.

Surgery Outcomes and Considerations

• Surgery is generally reserved for patients who do not improve after several months of conservative treatment 1 2 12.
• Outcomes are favorable, with the majority of patients experiencing significant symptom relief and improvement in function 11 12 13.
• Complications are uncommon but can include wound healing issues, nerve injury, or recurrence if inadequate bone is resected 1 12.
• The choice of surgical technique should be tailored to deformity type, patient age, activity level, and surgeon expertise 5 14 15.

Rehabilitation

A structured rehabilitation program following surgery is crucial for restoring tendon and joint function, gradually increasing activity, and preventing recurrence 1 12.

Conclusion

Haglund’s deformity is a multifaceted heel problem that requires a nuanced, individualized approach for effective management and optimal outcomes. Here’s what we covered:

• Symptoms: Heel pain, swelling, redness, stiffness, and a visible “pump bump” are classic signs. Associated issues like bursitis and tendinitis often coexist.
• Types: Several clinical and morphological types exist, with specific forms dictating the best treatment approach.
• Causes: High arches, tight Achilles tendon, genetics, rigid footwear, and repetitive stress are key contributors. Rarely, bone tumors may mimic the deformity.
• Treatment: Conservative measures are usually effective, including footwear changes, orthotics, physiotherapy, and medication. Surgery—open or minimally invasive—is reserved for persistent or severe cases, and must be tailored to the individual’s deformity type and needs.

Key Takeaways:

• Early recognition and management can prevent progression and complications.
• Understanding the type and cause of Haglund’s deformity is crucial for selecting the best treatment.
• Surgical innovations are improving outcomes for patients with complex or refractory cases.
• A multidisciplinary approach—including orthopedists, physiotherapists, and footwear specialists—yields the best results.

If you or someone you know struggles with persistent heel pain and a bothersome heel bump, seek evaluation by a foot and ankle specialist. Modern treatments offer real relief and a return to comfortable, active living.