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Health condition · Clinically reviewed

Haglund’s deformity, pump-bump heel - from heel lifts and shockwave to endoscopic bone resection.

A bony prominence on the back of the heel - often called "pump bump" - that irritates the Achilles insertion and retrocalcaneal bursa. Footwear changes and shockwave help early; endoscopic calcaneoplasty or open resection for refractory cases.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against BOFAS, NICE or peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK guidance on footwear, shockwave and endoscopic calcaneoplasty.

Key facts

Haglund’s deformity at a glance.

The essentials, in plain English - what Haglund’s deformity is, why it hurts, and what modern UK care actually looks like.

  • Definition

    Haglund’s deformity is a bony prominence on the posterior calcaneus - sometimes called a "pump bump" - that irritates the Achilles insertion and overlying bursa.

  • Frequent overlap

    Often coexists with insertional Achilles tendinopathy - the two problems are almost always considered together.

  • Footwear driven

    Strongly associated with rigid heel-counter shoes that press repeatedly on the posterior heel.

  • Retrocalcaneal bursitis

    The retrocalcaneal bursa lies between the bone and tendon - bursitis is a common related overlap.

  • MRI is definitive

    MRI shows the bony prominence, insertional Achilles tendinopathy and retrocalcaneal bursitis in one study.

  • Modern surgery

    Endoscopic calcaneoplasty is the modern minimally invasive option when conservative care fails.

Why this guide matters

Footwear first, surgery last.

Haglund’s deformity almost always improves with unglamorous first steps - footwear, offloading and rehab. This guide sets out that order clearly so nobody skips ahead.

  • Get out of rigid heel counters

    Removing pressure from the posterior heel - open-back shoes, heel lifts, silicone cups - settles a majority of cases before anything else is tried.

  • Rehab treats the overlap

    Eccentric calf work targets the coexisting insertional Achilles tendinopathy that so often drives the pain.

  • Endoscopic calcaneoplasty

    For refractory cases, minimally invasive resection of the bony prominence has faster recovery than open surgery.

How the diagnosis is made

From painful pump-bump to a clear plan.

The steps a UK GP or foot and ankle team will normally follow, in order - so you know what to expect and why.

  1. 01

    Recognising

    Symptom + footwear history

    Posterior heel pain worsened by rigid heel-counter shoes - the story usually points straight at the diagnosis.

  2. 02

    Recognising

    Palpation of posterior calcaneus

    A tender bony prominence at the back of the heel, often with visible swelling over the pump bump.

  3. 03

    Recognising

    Weight-bearing lateral X-ray

    A standing lateral X-ray is used to measure the Chauveaux–Liet angle - a validated radiographic assessment of posterior calcaneal prominence.

  4. 04

    Confirming

    Ultrasound of Achilles insertion

    Real-time assessment of the insertional Achilles tendon and retrocalcaneal bursa alongside the bony prominence.

  5. 05

    Confirming

    MRI for coexisting tendinopathy

    MRI is the gold standard for characterising insertional Achilles tendinopathy, bursitis and bone oedema together.

  6. 06

    Confirming

    Assess coexisting equinus

    A tight calf and equinus deformity often coexist and change the surgical plan - worth checking early.

  7. 07

    Managing

    Foot & ankle surgery consultation

    For refractory cases, referral to a foot and ankle surgeon to discuss endoscopic calcaneoplasty or open resection.

Typical timeline: 2–4 weeks from first appointment to a settled plan.

Symptoms

What Haglund’s deformity actually feels like.

The pattern is telling - a visible bony pump-bump, posterior heel pain and reliable aggravation from rigid heel-counter shoes.

  • Posterior heel pain

    Pain at the back of the heel, especially where shoes rub against the calcaneus.

  • Bony pump-bump

    A visible, palpable bony lump on the posterolateral heel - often reddened by shoe pressure.

  • Retrocalcaneal bursitis

    Swelling and tenderness between the Achilles tendon and calcaneus - a related overlap.

  • Insertional Achilles pain

    Pain and stiffness at the Achilles insertion, often coexisting with the deformity.

  • Aggravating footwear

    Rigid heel counters, dress shoes and ski boots reliably provoke symptoms - hence "pump bump".

  • Limping / altered gait

    People often adopt an antalgic gait to avoid heel contact, sometimes progressing to a persistent limp.

  • Recurrent symptoms

    Symptoms typically wax and wane over months - flaring with new footwear or increased activity.

  • Red flag

    Acute rupture of the insertional Achilles tendon - needs urgent surgical review.

Treatment

How Haglund’s deformity is treated in the UK.

A staged approach - footwear and rehab first, then shockwave and careful injection, with endoscopic calcaneoplasty or open resection for refractory cases.

  • Open-back shoes / heel lifts

    Removing pressure from the posterior heel is the single most useful first step - open-back shoes or a modest heel lift.

  • Silicone heel cups

    Cushioned silicone heel cups reduce shoe contact against the bony prominence and offload the Achilles insertion.

  • Physiotherapy (heel raises, eccentrics)

    Structured eccentric calf loading and heel-raise programmes - mainstay conservative rehab for the coexisting insertional tendinopathy.

  • Extracorporeal shockwave therapy

    ESWT has real evidence for insertional Achilles tendinopathy - usually 3–6 sessions over several weeks.

  • NSAIDs

    Short courses of NSAIDs can settle acute bursitis flares - used carefully alongside footwear changes and rehab.

  • Ultrasound-guided bursal injection

    Careful ultrasound-guided injection into the retrocalcaneal bursa - never into the tendon itself, given the risk of Achilles rupture.

  • Endoscopic calcaneoplasty

    The modern minimally invasive option - the bony prominence is resected endoscopically, with faster recovery than open surgery.

  • Open calcaneal exostectomy

    Open resection with Achilles debridement or FHL tendon transfer for severe insertional disease and larger deformities.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, podiatrist or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • British Orthopaedic Foot and Ankle Society (BOFAS). Patient information and clinical standards.

  • NICE. Musculoskeletal guidance on heel pain and Achilles tendinopathy.

  • American Orthopaedic Foot & Ankle Society (AOFAS). Patient education on Haglund’s deformity.

  • Chauveaux–Liet radiographic assessment of posterior calcaneal prominence.

Red flags

When posterior heel pain is not just Haglund’s.

Most posterior heel pain is mechanical and settles with footwear and rehab. These are the situations where a different problem needs to be considered.

  • Achilles insertional rupture

    Sudden pop or giving way at the back of the heel with weakness on push-off - urgent surgical assessment.

  • Retrocalcaneal abscess

    Increasing pain, redness, swelling and fever over the posterior heel - needs same-day review to exclude infection.

  • Diabetic heel ulcer

    A non-healing posterior heel ulcer in a person with diabetes - urgent podiatry and diabetic foot team review.

  • Post-op wound complication

    New drainage, swelling or wound breakdown after calcaneoplasty - contact the surgical team promptly.

  • Sural nerve injury

    New numbness or burning on the lateral foot after surgery - suggests sural nerve involvement.

  • Failed conservative therapy

    Persistent symptoms after 6+ months of footwear changes, rehab and shockwave - time to discuss surgery.

  • Recurrent deformity

    Return of bony prominence and symptoms after resection - imaging and surgical re-review are warranted.

  • Post-op Achilles rupture

    Sudden weakness or a palpable gap after any posterior heel surgery - urgent orthopaedic review.

  • Ankylosing spondylitis / enthesopathy

    Multi-site enthesopathy, morning stiffness and inflammatory back pain - screen for spondyloarthropathy rather than assuming mechanical disease.

Living with it

A slow condition, but a very manageable one.

Four things that make the biggest difference day to day - footwear, rehab, load management and patient review.

A quiet reminder

Consistency beats intensity, every time.

Small, steady changes - kept up for months - do more than a heroic week that does not last.

  1. 01 Footwear

    Get out of rigid heel counters

    Open-back shoes, softer heel counters and a modest heel lift take pressure off the posterior calcaneus - the single most useful daily change.

  2. 02 Rehab

    Do the eccentric work

    Consistent eccentric calf loading and heel-raise progressions over months - dull, unglamorous and the biggest long-term lever.

  3. 03 Load

    Manage impact activity

    Break up long standing sessions, moderate high-impact activity while symptoms are active, and reintroduce gradually.

  4. 04 Reviews

    Reassess in months, not days

    Rehab and shockwave take weeks to months to work - reassess at 6–12 weeks, and consider surgical opinion if things have stalled.

Frequently asked

Everything we get asked about Haglund’s deformity.

Quick answers on footwear, shockwave, injections, endoscopic surgery and when to seek help.

  • What actually causes Haglund’s deformity?

    It is a bony prominence on the back of the heel - often called a "pump bump" - that develops or becomes symptomatic when rigid heel-counter shoes press repeatedly on the posterior calcaneus. It commonly coexists with insertional Achilles tendinopathy and retrocalcaneal bursitis.

  • Do I need surgery for Haglund’s deformity?

    Most people do not. Footwear changes, heel cups, eccentric rehab and shockwave settle the majority of cases. Surgery - endoscopic calcaneoplasty or open resection - is reserved for genuinely refractory disease after 6+ months of good conservative care.

  • What is endoscopic calcaneoplasty?

    Endoscopic calcaneoplasty is a minimally invasive procedure where the bony prominence is resected through small keyhole incisions. It has faster recovery and less wound morbidity than open exostectomy, and is now the preferred technique in many centres.

  • Can I have a steroid injection?

    A careful ultrasound-guided injection into the retrocalcaneal bursa can settle acute bursitis, but steroid must never be injected into the Achilles tendon itself - the rupture risk is real and serious.

  • Does shockwave therapy actually help?

    Yes - extracorporeal shockwave therapy (ESWT) has genuine evidence for the coexisting insertional Achilles tendinopathy that so often drives symptoms. A typical course is 3–6 sessions over several weeks.

  • What is the red flag I should not ignore?

    Sudden pop, weakness or a palpable gap at the back of the heel - this can represent an insertional Achilles rupture and needs urgent surgical assessment. Fever with a hot, swollen heel needs same-day review to exclude infection.

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