Haglund’s deformity is a bony enlargement on the back of the heel bone, where the Achilles tendon attaches. It can rub the tendon and the bursa (a small fluid-filled cushion) and cause pain, swelling and a visible bump. Most people improve with non-surgical care. Surgery is for those who do not.
That is the short version. Below you will find what causes the bump, how it connects to retrocalcaneal bursitis, which home measures help, what to ask about injections, and when surgery is worth considering. If you live in the Las Vegas area, we explain how we approach it at Stride Foot & Ankle.
TL;DR
- Haglund’s deformity is a bony prominence on the back of the heel. Retrocalcaneal bursitis is the inflamed cushion that often comes with it.
- Conservative care works for roughly 60% to 80% of patients: shoe changes, heel lifts, stretching, activity changes, anti-inflammatories and orthotics.
- Surgery is typically considered after 3 to 6 months of failed conservative care, and recovery is significant.
- Be cautious with steroid injections near the Achilles tendon, because they may weaken it.
- Persistent back-of-heel pain deserves an exam by a foot and ankle specialist, not just new shoes.
Table of Contents
- What is Haglund’s deformity?
- What causes a bump on the back of the heel?
- What are the symptoms?
- How is Haglund’s deformity diagnosed?
- How do you treat retrocalcaneal bursitis and Haglund’s deformity without surgery?
- Does sleeping position matter?
- What about injections for retrocalcaneal bursitis?
- When is surgery the right answer?
- Our perspective: conservative first, surgery when it is earned
- Care for your heel in Las Vegas
- Frequently asked questions
- Sources
What is Haglund’s deformity?
Haglund’s deformity is an enlargement of the upper back corner of the heel bone (the calcaneus). The American Podiatric Medical Association describes it as a bony enlargement that irritates the soft tissue near the Achilles tendon when it rubs against shoes. It is sometimes called a “pump bump” because it is often seen in women who wear pumps.
The bump itself is bone. It does not hurt on its own in many people. Pain starts when the bone pinches or rubs the tissue around it. Two structures are usually involved:
- The retrocalcaneal bursa, a cushion between the Achilles tendon and the heel bone. When it is squeezed repeatedly it becomes inflamed. This is retrocalcaneal bursitis.
- The Achilles tendon insertion, where the tendon meets the bone. Irritation here is called insertional Achilles tendinopathy.
The surgical literature uses the term retrocalcaneal exostosis for the bony prominence itself. A 2022 systematic review notes that this prominence at the back of the heel can often lead to retrocalcaneal bursitis, a significant cause of posterior heel pain.
Haglund’s deformity, Haglund’s syndrome and retrocalcaneal bursitis: how they differ
These terms overlap, which confuses many patients. Here is a simple way to separate them.
| Term | What it means | Where the problem is |
|---|---|---|
| Haglund’s deformity | A bony bump on the back of the heel | Bone |
| Retrocalcaneal bursitis | Inflammation of the bursa in front of the Achilles tendon | Soft tissue cushion |
| Insertional Achilles tendinopathy | Tendon irritation or degeneration where it attaches to the heel | Tendon |
| Haglund’s syndrome | The bump plus the painful soft tissue problems it causes | All of the above |
You can have the bump without pain. You can also have bursitis without a prominent bump. The combination is what usually sends people to a podiatrist.
What causes a bump on the back of the heel?
The cause is a mix of foot shape and repeated friction. The APMA lists the shape of your foot as a factor, along with a high arch, a tight Achilles tendon and a tendency to walk on the outside of the heel. Rigid shoes with a stiff back, such as pumps, dress shoes, ice skates and some cleats, can then rub the area again and again.
Common contributors include:
- Foot structure. A high arch tilts the heel bone so the back corner presses harder into the shoe. If this sounds familiar, see our guide to high arched feet.
- A tight Achilles tendon or calf. Less flexibility means more pull and pressure at the heel.
- Stiff heel counters. The rigid cup at the back of a shoe is the usual point of friction.
- Repetitive loading. Running, court sports and long days on your feet add stress to the heel.
- Gait mechanics. Expert podiatrists stress that the aim is to reduce the mechanical stress that caused the bone to grow, which often means a gait assessment, according to the APMA.
Achilles pain in general is common. A contemporary review cites an estimate that 6% of the general population will have Achilles tendon pain at some point, and that insertional tendinopathy accounts for 33% of those cases.
What are the symptoms?
The typical picture is pain and a visible or palpable bump at the back of the heel, often worse when a shoe presses on it. Look for these signs:
- A hard bump on the back or side of the heel.
- Tenderness and swelling that sit where the shoe’s heel counter rubs.
- Redness or warmth over the bump after wearing closed-back shoes.
- Pain when you push off, climb stairs or walk uphill.
- Stiffness at the back of the heel first thing in the morning.
- A blister or thickened skin over the bump.
Heel pain has many causes, so do not assume it is this. The RadioGraphics review of the heel explains that the differential diagnosis for heel pain is broad and mainly involves the Achilles tendon, the heel bone and the plantar fascia. Pain under the heel that is worst with the first steps of the day points more toward the plantar fascia. Our article on morning heel pain helps you tell the patterns apart, and our plantar fasciitis stretch plan covers that condition.
When to see a podiatrist
Book an exam if back-of-heel pain lasts more than a couple of weeks despite changing shoes, if you are limping, or if the swelling keeps coming back. Seek care promptly after a sudden pop or sharp pain in the heel or calf, or if you cannot rise onto your toes, since those can signal an Achilles tear. If you have diabetes or poor circulation, do not wait: a rubbing bump can break the skin. Our guide to limping explains why a changed walking pattern should never be ignored.
How is Haglund’s deformity diagnosed?
Diagnosis combines a physical exam with imaging. A specialist will press along the back of the heel, check calf and Achilles flexibility, look at your arch and gait, and ask about footwear and activity. X-rays show the shape of the heel bone. Ultrasound or MRI can show bursitis and the condition of the tendon.
The tendon matters more than most patients expect. As the contemporary review explains, surgeons must distinguish a simple bump from bump plus insertional Achilles tendinopathy, because the two call for different procedures. A bone-only resection can disappoint if tendon disease underneath is ignored.
How do you treat retrocalcaneal bursitis and Haglund’s deformity without surgery?
Non-surgical care is the first step and often the only one needed. A 2024 review in PubMed Central reports that conservative management succeeds in 60% to 80% of patients, and that it fails in 20% to 40%. The bump itself does not shrink. The goal is to calm the irritated tissue and stop the rubbing.
Step 1: Take pressure off the back of the heel
- Switch to backless or soft-backed shoes such as clogs, slides or sandals while the area is sore.
- Use a heel lift or a shoe with a moderate heel. A University of Colorado foot and ankle handout lists a heel lift or a moderate heel as part of initial treatment, because it reduces tendon stress and irritation.
- Add heel pads or a gel cushion where the shoe rubs.
- Check the heel counter. If a shoe has a stiff, tall, sharp-edged back, it is probably the culprit. Soft padding or a different style can help.
The APMA’s expert guidance is that backless shoes and pads give immediate relief but are only bridges to long-term healing. They treat the symptom, not the mechanics behind it.
Step 2: Stretch and strengthen carefully
The same Colorado handout includes regular calf stretching to improve the flexibility of the calf and Achilles. Stretching is gentle and should never be forced into sharp pain at the heel. Use these simple versions:
- Wall calf stretch. Stand facing a wall, one leg back with the heel down and knee straight. Lean forward until you feel a pull in the calf. Hold 30 seconds, repeat 3 times, twice a day.
- Bent-knee stretch. Same position, but bend the back knee slightly to reach the lower calf.
- Gentle loading under guidance. Heel-raise programs are common for insertional problems, but on a step the heel drop can compress the tendon against the bump. Start with a clinician’s plan. Our Achilles tendinopathy rehab guide outlines a 12-week framework and the two loading paths athletes follow.
People searching for heel bursitis exercises often find lists that include deep heel drops. For Haglund’s deformity, ask first whether that movement suits you, since the bump may pinch the tissue in that position.
Step 3: Calm the inflammation
Ice after activity and anti-inflammatory medication can ease symptoms. The Colorado handout is blunt that anti-inflammatories help manage symptoms but do not address the underlying problem. Check with your doctor or pharmacist before taking them if you have kidney disease, stomach ulcers, heart disease or take blood thinners.
Step 4: Address the mechanics with orthotics
If a high arch, a tilted heel or an unusual gait is driving the friction, a custom device can change how load reaches the heel. Orthotics are one of the standard conservative tools named in the contemporary review, alongside physical therapy, activity modification and anti-inflammatories. To understand what a custom device involves, read what custom orthotics are and how they work and orthotics for foot pain.
Step 5: Protect the heel in sport shoes
If you play soccer, run or skate, the footwear is often what flares the bump. New cleats and boots are stiff at the heel and need breaking in. A German-language guide to breaking in soccer cleats walks through a gradual practice plan. Whatever the sport, introduce stiff shoes in short sessions and stop if the back of your heel starts to burn.
A realistic example
Consider a teacher who spends the school day in dress flats and develops a tender bump on her right heel. She swaps to a soft-backed shoe, adds a small heel lift, stretches her calves twice a day and wears a supportive insert at home. For many people in her position, the rubbing stops within weeks and pain fades. If it does not after a few months, that is the signal to look at imaging and other options, not to push through. This is an illustration of the usual path, not a promised result.
Does sleeping position matter?
It can, if you also have Achilles pain. Clinical reviews suggest avoiding positions that hold the foot pointed down for long periods, because that can shorten the Achilles tendon and worsen morning symptoms, as noted in the contemporary review. Practical options:
- Sleep on your back or side with the foot relaxed, not pointed down against the mattress.
- Keep blankets loose so they do not push your toes downward.
- Ask about a night splint that holds the foot near 90 degrees if mornings are your worst time.
If you lie on your stomach, letting your feet hang off the end of the bed keeps them from pointing. Talk to your podiatrist before buying a splint, since fit and wearing time matter.
What about injections for retrocalcaneal bursitis?
Injections are an area for caution. Corticosteroids can reduce inflammation quickly, but the heel is not a forgiving place for them. The RadioGraphics heel review is the reference for this, and the key point is that steroid near the Achilles tendon can weaken it and raise the risk of later rupture.
Before agreeing to a steroid injection at the back of the heel, ask your podiatrist:
- How close will the needle be to the Achilles tendon, and will it be image-guided?
- What is the risk of tendon damage in my case?
- What non-steroid alternatives exist for me?
- How will we measure whether it helped?
Some patients with tendon and ligament injuries are candidates for biologic options. At our practice we offer amnion injections as a non-surgical option for tendon and ligament injuries. Whether that suits a particular heel depends on your exam and imaging, and we will tell you plainly if it does not.
When is surgery the right answer?
Surgery is considered when pain persists after a proper trial of conservative care. The PubMed Central review puts the usual threshold at 3 to 6 months of failed conservative treatment. A 2022 meta-analysis likewise says surgery is indicated for symptomatic patients after a period of conservative treatment.
The operation removes the prominent part of the heel bone and, when needed, treats the tendon and bursa. There are two main approaches:
| Open resection | Endoscopic resection | |
|---|---|---|
| Incision | One larger cut at the heel | Small portals, camera guided |
| Operating time | May be shorter | May be longer |
| Long-term function | No significant difference found | No significant difference found |
A 2026 systematic review and meta-analysis found no statistically significant functional difference in long-term outcomes between open and endoscopic techniques. That means the better choice depends on your anatomy and tendon condition and on your surgeon’s training, not on a trend.
The question patients forget to ask
Does my tendon need work too? If insertional Achilles tendinopathy is present, the surgeon may need to debride the damaged tendon or detach and reattach it. This substantially changes recovery compared with removing bone alone. Surgery is not a quick fix: expect protected weight-bearing, a period in a boot or cast and structured rehabilitation. Ask for the expected timeline in writing for your specific procedure. For general background, our overview of ankle surgery types, risks and recovery explains what surgical recovery usually involves.
Our perspective: conservative first, surgery when it is earned
We see back-of-heel pain differently from a shoe-shopping problem. A stiff shoe may be the trigger, but the bump is the result of how your foot is built and how it loads. That is why we start with the question of why the heel is rubbing, not only how to stop the pain this week.
Our approach follows the same order the research supports. We examine the foot and gait, look at the tendon, and begin with conservative care: shoe changes, padding, stretching, activity changes and orthotics where they make sense. Dr. Nahad Wassel is a board-certified foot and ankle surgeon, so when a patient does reach the point where surgery is the honest answer, the person who explains the options is also trained to perform them. We would rather you hear that surgery is not needed yet than be hurried toward it.
We also tell patients to be wary of quick fixes in either direction. Pushing through pain in a rigid shoe prolongs the problem, and so does an injection that numbs symptoms while the tendon is at risk. Good care in the Las Vegas area, where many people spend long days on their feet, on hard floors or in work footwear, means matching the plan to your job, shoes and goals, so you can get back on your feet and start striding confidently.
— Ramil
Care for your heel in Las Vegas
If back-of-heel pain has not eased, we can examine the heel, assess the tendon and build a plan, from orthotics and bracing to surgical options if you need them. Learn about our general foot and ankle care and orthotics, read about surgical care with Dr. Wassel, or visit Stride Foot & Ankle to request an appointment. We also offer second opinions if you have already been told you need surgery.
Frequently asked questions
How do you fix Haglund’s deformity?
Most people start with non-surgical care: roomier or backless shoes, heel lifts and pads, calf stretching, anti-inflammatory medication and orthotics. This works for roughly 60% to 80% of patients, according to a PubMed Central review. If pain persists after 3 to 6 months, surgery to remove the bony prominence may be considered.
What happens if Haglund’s deformity is left untreated?
The bump does not go away on its own, and continued rubbing can keep the bursa and Achilles tendon inflamed. Over time that may mean persistent pain, a limp and more limited activity. Early changes to footwear and mechanics are usually simpler than treating long-standing tendon problems, so see a podiatrist if symptoms linger.
What causes Haglund’s deformity?
It develops from a combination of foot structure and repeated friction. A high arch, a tight Achilles tendon and a tendency to walk on the outside of the heel are listed risk factors by the APMA. Stiff-backed shoes then rub the heel repeatedly.
What is the best sleeping position for someone with Achilles tendonitis?
Choose a position that keeps the foot relaxed and near a neutral 90 degrees rather than pointed down for hours. Sleeping on your back or side with loose blankets is usually better than lying on your stomach with toes pressed into the mattress. A neutral-position night splint may help, so ask your podiatrist first.
Can retrocalcaneal bursitis go away without treatment?
Mild bursitis can settle when you remove the source of friction and rest the area. If a bony bump or tendon problem is behind it, symptoms tend to return when you go back to the same shoes and activities. Persistent or recurring swelling is a reason for an exam.
Sources
- Haglund’s Deformity, American Podiatric Medical Association
- Minimally Invasive Approaches to Haglund’s Deformity and Insertional Achilles Tendinopathy: A Contemporary Review
- The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment, RadioGraphics
- Open vs Endoscopic Surgical Treatment for Haglund Deformity: A Systematic Review, Meta-analysis, and Meta-regression
- Surgical Treatment of Haglund’s Deformity: A Systematic Review and Meta-Analysis
- Haglund’s Deformity patient handout, CU Orthopedics Foot & Ankle
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