You’ve noticed a tender swelling at the back of your heel again. A shoe that used to feel comfortable now presses where it didn’t before. You might have dismissed it as a shoe-fit issue or a minor Achilles strain—but what if the underlying cause is something more structural: a bony enlargement known as Haglund’s deformity.
This condition can set the stage for irritation, inflammation, and injury of the large tendon at the back of the heel: your Achilles tendon. At Austin Foot and Ankle Specialists, board‐certified foot and ankle surgeon Craig H. Thomajan and his team focus on education, diagnosis, and individualized care—because healthy feet lead to a happier life.
If heel pain or Achilles tendon tightness has been slowing you down, this article will help shed light on what’s really happening—and how it’s addressed.
What Is Haglund’s Deformity?
Haglund’s deformity is defined as an enlargement or bony prominence on the back (posterior) and upper aspect of the heel bone (calcaneus) where the Achilles tendon attaches.
Often called “pump bump” because certain rigid‐backed shoes aggravate it, the condition involves more than just a visible bump. It’s about how that bony prominence interacts with surrounding soft tissues, especially the Achilles tendon and the bursa that sits between bone and tendon.
When that bump rubs against shoes or presses repeatedly against the tendon/soft tissue, it can trigger symptoms of irritation, inflammation, and in chronic cases, tendon degeneration.
How Haglund’s Deformity Affects the Achilles Tendon
Because the Achilles tendon is the body’s largest and most frequently loaded tendon—it transmits force from the calf muscles to the heel for walking, running, jumping—any structural changes at its attachment site can have outsized implications.
A Mechanical Problem with a Soft Tissue Toll
The bony prominence of Haglund’s deformity can create a scenario of repeated microtrauma: each step may cause the bump to press into the tendon insertion, or into the retro-calcaneal bursa (the fluid-filled sac between bone and tendon). Over time this mechanical stress leads to:
- Chronic friction. The tendon rubs against the bony projection or the shoe-heel counter, creating irritation of tendon fibers or the bursa.
- Swelling and inflammation. The bursa may become inflamed (retrocalcaneal bursitis), and the insertion of the Achilles tendon may show signs of tendonitis or tendinosis.
- Degenerative changes in the tendon. Over time, repeated irritation may lead to breakdown of tendon fibres, calcification, and compromised strength—often referred to as insertional Achilles tendinopathy.
- Pain and impaired function. As the tendon becomes involved, walking, running, rising on toes, or wearing certain shoes may become painful or limited.
Because of this interplay of bone structure and soft tissue, Haglund’s deformity is not simply a cosmetic or isolated heel issue—it directly threatens Achilles tendon health.
Why This Condition Develops (and Who’s at Risk)
Haglund’s deformity doesn’t appear out of thin air—it often results from a combination of anatomical predisposition, footwear/environments, and tendon/soft tissue tension.
Underlying Structural and Biomechanical Contributors
Some of the common risk factors and contributing elements include:
- High‐arched feet (pes cavus). A high arch may increase pressure on the posterior heel and alter the angle at which the Achilles inserts.
- Tight Achilles tendon/calf muscles. Limited flexibility in the gastrocnemius/soleus complex increases the tension at the tendon insertion and may exacerbate pressure on the heel prominence.
- Rigid‐backed or ill‐fitting footwear. Shoes with stiff heel counters or narrow back profiles (such as dress shoes, pumps, ice skates) can repeatedly rub and aggravate the bump.
- Walking/running mechanics. Supination (walking on the outer edge of the foot) or heel lever patterns may increase the load at the heel‐tendon interface.
- Hereditary foot shape. Some people inherit calcaneal shapes predisposed to developing this posterior bump.
Given the combined influence of structure + mechanics + external pressure, formation of the bony prominence and its effect on the Achilles tendon become more likely over time.
Signs and Symptoms to Watch For
Early recognition of the condition can mean prompt intervention—before the Achilles tendon sustains significant damage.
When Haglund’s deformity begins to affect the Achilles tendon, patients may notice:
- Pain at the back of the heel. Particularly where the Achilles tendon inserts into the heel bone. The pain often worsens with activity, or when wearing shoes that contact the back of the heel.
- Visible bump or prominence. A firm lump at the back upper heel, which may become more prominent or tender.
- Swelling, redness, or warmth. Especially around the area where the tendon meets the bone or the bursa sits.
- Stiffness or reduced ankle/heel mobility. Particularly after rest, or when first walking in the morning.
- Skin irritation or blistering. Especially when the shoe’s heel counter rubs the bump.
- Shoes feel uncomfortable at the heel. What once felt fine now presses or causes discomfort/pressure sensation.
Because the Achilles tendon is involved, symptoms may progress from heel discomfort to more aggravated tendon pain, making early detection vital.
Diagnosing the Link Between Haglund’s Deformity and the Achilles Tendon
At Austin Foot and Ankle Specialists, the diagnostic process emphasizes both the bony prominence and its soft tissue consequences.
- History and physical exam. The doctor will ask about heel/back-of-heel pain, shoe habits, activity level, prior injuries, and evaluate foot shape, Achilles flexibility, and the prominence of the heel bump.
- Imaging studies. X-rays of the lateral heel reveal the bony enlargement. Ultrasound or MRI may assess tendon involvement (thickening, degeneration, tears) or inflamed bursa.
- Biomechanical assessment. Your doctor may evaluate foot posture, gait analysis, ankle and calf flexibility to identify contributing factors.
- Differential diagnosis. Because heel pain can stem from many causes (e.g., plantar fasciitis, posterior heel spur, Achilles mid‐portion tendinopathy), careful exclusion is important.
This thorough diagnostic pathway ensures the treatment plan addresses both the bone and the tendon—rather than treating one symptom in isolation.
Treatment Options When Haglund’s Deformity Affects the Achilles Tendon
Intervention goals focus on reducing pressure and friction on the tendon insertion, promoting tendon healing, and in some cases reshaping the heel to prevent future irritation.
Conservative Measures (First-Line)
Most cases begin with non‐surgical options aimed at relieving tendon stress and modifying aggravating factors. These include:
- Footwear modifications. Choose shoes with soft or open backs, avoid rigid heel counters or high‐back dress shoes.
- Heel lifts or orthotics. Lift or pad the heel to reduce direct contact between the prominence and the shoe; custom orthotics can correct foot posture and reduce tendon load.
- Stretching and physical therapy. Calf and Achilles stretches (e.g., heel drop, heel raise exercises) and strengthening of supporting muscles to improve flexibility and reduce tendon tension.
- Activity modification and offloading. Reducing high-impact activity, avoiding shoes that aggravate the heel, icing, anti‐inflamatories (NSAIDs) to manage tendon inflammation.
- Padding/back-of-heel protection. Soft heel pads or cushioning at the heel counter reduce friction and irritation from shoes.
These measures may not eliminate the bony bump itself—but when effectively applied early, they can resolve pain and prevent further tendon damage.
When Surgery Becomes Necessary
If conservative care fails, and tendon involvement is significant (thickened tendon, partial tear, persistent bursitis), surgical intervention may be indicated.
Key surgical options may include:
- Resection of the bony prominence. Removing or shaving the heel bump to create a smoother heel‐tendon interface.
- Debridement or repair of the Achilles tendon. If the tendon has degenerated or torn, diseased tissue may be removed or repaired.
- Bursa excision. If the retrocalcaneal bursa is chronically inflamed, it may be removed.
- Calcaneal osteotomy. In some cases, adjusting the orientation of the heel bone may reduce stress at the tendon insertion.
Post-operatively, patients often wear a boot or cast with a heel lift, undergo physical therapy, and carefully progress weight‐bearing based on the extent of tendon repair.
Recovery timelines vary—some may be walking after a few weeks; full return to high‐impact activity may take several months.
Why Early Attention Makes a Difference
When Haglund’s deformity starts affecting the Achilles tendon, delaying treatment can allow the condition to progress from simple irritation to significant tendon degeneration or even rupture.
- Early intervention helps preserve tendon structure and function.
- Modifying shoes, reducing friction, and stretching early can avoid more invasive care.
- Once tendon fibers are compromised, recovery time lengthens and outcomes may be less optimal.
- Correction of biomechanical and external factors early improves long-term durability of the tendon and heel interface.
In short: diagnosing and addressing the heel–tendon interaction at an early stage gives the best chance for returning to comfortable, normal activity.
Long-Term Implications of Untreated Heel–Tendon Interaction
While a visible heel bump may seem benign, when left unchecked the consequences can ripple into mobility, comfort, and activity levels.
- Progressive tendon degeneration may make even routine walking painful or stiff.
- Persistent bursitis and heel irritation may lead to skin changes, calluses, or chronic discomfort.
- In athletes or active individuals, the limitation may force a reduction in training or performance.
- In severe cases, a full ruptured Achilles tendon may result, requiring significantly more complex treatment.
- Even when doctors perform surgery, longer treatment and rehabilitation may be required if the tendon damage is advanced.
It’s crucial to understand that the condition is more than a cosmetic heel protrusion. Rather, it’s a structural and functional issue at the interface of bone, tendon, and shoe environment. This understanding is essential for appreciating why treatment matters.
Getting Targeted Treatment for Haglund’s Deformity and Achilles Tendon Pain
At Austin Foot and Ankle Specialists, Dr. Thomajan and his team are committed to patient education and individualized care. Whether the treatment plan begins with optimized footwear, stretching and orthotics, or proceeds to advanced imaging and surgical correction, the objective remains the same: preserve your Achilles tendon health and get you back on your feet with comfort and confidence.
If you’ve been dealing with back-of-heel pain, stiffness, or tendon irritation, learning more about the relationship between a heel bump and Achilles tendon health may reveal the root cause—and offer a path forward for lasting relief.
