Haglund’s Deformity

Haglund’s Deformity: When Heel Pain Won’t Go Away—and How Minimally Invasive Surgery Is Changing Treatment

By Dr. Bryanna Vesely, Foot & Ankle Specialist

If you’ve noticed a painful bump on the back of your heel that seems to rub against every pair of shoes you own, you’re not alone.

Many patients come to my office complaining of pain where the back of the shoe presses against the heel. Whether they’re wearing running shoes, work shoes, or even dress shoes, the discomfort can become so persistent that walking, exercising, and everyday activities become frustrating.

One of the most common causes of this type of pain is Haglund’s deformity, sometimes referred to as a “pump bump.”

The good news? Most patients improve without surgery, and for those who do require an operation, today’s minimally invasive techniques offer a less disruptive alternative than traditional surgery.

What Is Haglund’s Deformity?

Haglund’s deformity is a bony enlargement on the back of the heel bone (calcaneus) where the Achilles tendon attaches.

As this bony prominence develops, it repeatedly rubs against shoes and can irritate the surrounding tissues.

Over time, patients may also develop:

• Insertional Achilles tendinitis, or inflammation where the Achilles tendon attaches to the heel
• Retrocalcaneal bursitis, an inflammation of the small fluid-filled sac that cushions the Achilles tendon against the heel bone

Together, these conditions can make even simple daily activities uncomfortable.

Common Symptoms of Haglund’s Deformity

Patients often describe:

• Pain at the back of the heel
• Swelling around the Achilles tendon
• Redness and tenderness
• A noticeable bump on the heel
• Pain when wearing shoes with a firm heel counter

Because the Achilles tendon is involved in nearly every step we take, symptoms often worsen with activities such as:

• Walking
• Running
• Climbing stairs
• Rising onto your toes
• Flexing your foot up or down

In many cases, patients eventually begin avoiding certain shoes altogether because of persistent irritation.

Why Does It Hurt So Much?

The Achilles tendon is the largest tendon in the body and experiences tremendous force every time you walk, run, or jump.

When a bony prominence repeatedly rubs against the tendon and surrounding bursa, inflammation develops. That inflammation—not just the bone itself—is often what causes the pain. As irritation continues, the cycle of inflammation and friction can become increasingly difficult to break without treatment.

Conservative Treatment Comes First

One of the most common questions I hear is:

“Do I need surgery?”

Fortunately, the answer is usually no—not initially. Most patients should begin with nonoperative treatment, which may include:

• Shoe modifications
• Heel lifts
• Stretching exercises
• Physical therapy
• Activity modification
• Anti-inflammatory medications

These treatments reduce stress on the Achilles tendon while allowing inflammation to calm down.

Many patients improve significantly without ever needing surgery.

When Is Surgery Recommended?

If symptoms continue despite several months of appropriate conservative treatment, surgery may become an option. Before making that decision, we perform a thorough evaluation.

This typically includes:

• A detailed physical examination
• X-rays to evaluate the bony prominence
• MRI when necessary to assess the health of the Achilles tendon

This imaging helps determine whether the tendon itself has significant degeneration, which may influence the type of procedure that’s recommended.

How Minimally Invasive Surgery Has Changed Treatment

Traditionally, Haglund’s deformity was treated through a relatively large incision on the back of the heel.

While effective, traditional surgery required significant soft tissue dissection and often involved partially detaching and repairing the Achilles tendon.

Because the skin over the back of the heel has a limited blood supply, wound healing could sometimes be prolonged.

Today, advances in minimally invasive foot and ankle surgery have changed that.

Using specialized instruments through very small incisions—and fluoroscopic imaging for precision—we can often remove the painful bony prominence while minimizing disruption to the surrounding tissues.

One of the biggest advantages is that the Achilles tendon can often be preserved without extensive detachment, allowing for less soft tissue trauma during surgery.

Benefits of a Minimally Invasive Approach

For carefully selected patients, minimally invasive surgery may offer several advantages over traditional open procedures, including:

• Smaller incisions
• Less postoperative pain
• Reduced scarring
• Lower risk of wound complications
• Less disruption to the Achilles tendon
• Earlier return to comfortable shoe wear
• Faster recovery for many patients

Every patient is different, but preserving healthy tissue whenever possible is an important part of modern foot and ankle surgery.

What Recovery Looks Like

Recovery depends on the severity of the condition and the exact procedure performed.

Many patients are able to begin protected weight bearing relatively early, followed by physical therapy to restore:

• Strength
• Flexibility
• Balance
• Normal walking mechanics

Improvement occurs gradually over several months as inflammation resolves and tissues continue healing.

The Bottom Line

Heel pain isn’t something you should simply learn to live with.

If you’ve developed persistent pain at the back of your heel—especially if it limits your ability to exercise, work, or wear the shoes you enjoy—it’s worth being evaluated.

Most patients improve with conservative treatment, and surgery is reserved for those whose symptoms persist despite appropriate nonoperative care.

For patients who do require surgery, minimally invasive techniques have transformed the way we treat Haglund’s deformity, offering effective pain relief with less disruption to the surrounding tissues and a smoother recovery for many individuals.

The goal isn’t simply to remove a painful bump.

It’s to help you get back to walking, exercising, and living comfortably again.