Haglund’s Deformity. Why Is There a Painful Bump at the Back of My Heel?
12 November 2026
By Mark Reyneker, BTech (Podiatry), MSc (Palaeontology), Registered Podiatrist, Foot & Gait Specialist | Founder & Clinical Director, Family Podiatry Centre
Published: 06 November 2026 | Last reviewed: 06 November 2026
Haglund’s deformity is a bony prominence at the upper back of the heel. It can be painless, rub against the back of a shoe, or occur alongside irritation of the nearby Achilles tendon and a small cushioning sac called a bursa. If the bump hurts, where and when you feel the pain can help identify what needs attention.
Haglund’s deformity is a bony prominence at the upper back of the heel. It can be painless, rub against the back of a shoe, or occur alongside irritation of the nearby Achilles tendon and a small cushioning sac called a bursa. If the bump hurts, where and when you feel the pain can help identify what needs attention.
You slip on a pair of shoes and feel the heel press against the same spot every time. In sandals it barely bothers you. Then you notice that walking uphill or pushing off during a run brings on a deeper ache, even in shoes that feel comfortable. Those two experiences can happen at the same heel, and the difference between them is one of the first things I want to understand when I examine it.
What exactly is Haglund’s deformity?
The heel bone, or calcaneus, has a natural contour where its upper surface curves down towards the back of the heel. In some people that corner is more prominent. This is the shape referred to as Haglund’s deformity. You might also hear the term “pump bump,” a nickname that comes from the way a firm shoe back can press against the area.
The Achilles tendon attaches to the back of the heel bone. Just in front of the tendon, near that attachment, sits the retrocalcaneal bursa, a small fluid-filled sac that helps the tendon glide past the bone. A separate, more superficial bursa can become irritated between the skin and the tendon. All of these structures sit close together, which helps explain why a hard bump and a soft swelling can appear in the same area.
Haglund’s deformity
A bony prominence at the upper back of the heel.
Retrocalcaneal bursitis
Irritation of the small sac deep between the Achilles tendon and the heel bone.
Insertional Achilles tendinopathy
A painful problem where the Achilles tendon attaches to the heel. “Insertional” means at the attachment.
Haglund’s syndrome
A term often used when the bony prominence occurs with symptoms and irritation of surrounding tissues, such as the bursa or tendon.
Haglund’s deformity
A bony prominence at the upper back of the heel.
Retrocalcaneal bursitis
Irritation of the small sac deep between the Achilles tendon and the heel bone.
Insertional Achilles tendinopathy
A painful problem where the Achilles tendon attaches to the heel. “Insertional” means at the attachment.
Haglund’s syndrome
A term often used when the bony prominence occurs with symptoms and irritation of surrounding tissues, such as the bursa or tendon.
The terms overlap in everyday use. In clinic, naming the tissue that hurts is more helpful than relying on the label alone.
Why can a bump that’s been there for years suddenly hurt?
Think about two ways the back of the heel can be irritated. The first is pressure from outside. A stiff heel counter, the firm part at the back of a shoe, can press directly on the bump. Tenderness that comes on mainly in a particular pair of shoes gives us a clue to look closely at that point of contact.
The second is load and compression around the Achilles attachment. The tendon carries load when you push off. As your ankle bends and your shin moves forward over your foot, the tendon can also be pressed against the heel bone near its attachment. That helps explain why stairs, hills or running can provoke pain even when the shoe itself feels comfortable. Changes in activity are worth discussing alongside changes in footwear.
These patterns can overlap. I ask patients to point with one finger to the sorest spot and tell me what brings it on. Pain where a shoe makes contact, a deeper ache beside the tendon, and pain during a heel raise each give us a different clue. The examination brings those clues together.
Does a bigger bump mean more pain?
You can have a prominent heel bone and no pain at all. One radiographic study found broadly similar Haglund measurements in people with and without insertional Achilles tendinopathy. A later study found that some measures of bump size were associated with tendon changes on MRI, while several traditional X-ray measurements showed no such association. Taken together, these studies suggest that heel shape can be part of the picture and that a measurement alone has limited value for explaining an individual patient’s pain.
There is also a distinction between a Haglund prominence and an insertional heel spur. The prominence is part of the upper-back contour of the heel bone. An insertional spur is a bony projection that forms where the Achilles attaches. The two can appear on the same X-ray, and both can be described casually as a “bump.”
What happens at a podiatry assessment?
At Family Podiatry Centre, we start by asking when the pain began and what brings it on. We examine the bump, the Achilles attachment and the tissues around it. Depending on your symptoms, we may look at ankle movement, watch you walk or see how the heel responds when you rise onto your toes. If one particular pair of shoes sets it off, bring it along. Seeing exactly where the shoe contacts the heel can help us understand what happens when you wear it.
Imaging can help when there’s a specific question. An X-ray shows the contour of the heel bone and can identify an insertional spur. Ultrasound can help assess the tendon and look for fluid or swelling in the bursa. MRI may be considered when the examination and initial imaging leave uncertainty, or when another problem is suspected. The findings are interpreted alongside where you hurt and which movements reproduce the pain.
What can be done about it?
Treatment depends on what is driving the pain. When shoe contact is the main issue, the first discussion is usually about reducing pressure at the back of the heel. When the Achilles attachment is involved, we may discuss changes to your activity and a gradual strengthening plan that accounts for how the tendon responds to compression.
Surgery is considered in selected cases when symptoms persist despite appropriate non-surgical care. If the pain started suddenly with a pop or snap and you’re struggling to push off or stand on tiptoe, seek urgent medical assessment. Those symptoms can occur with an Achilles tendon rupture.
Surgery is considered in selected cases when symptoms persist despite appropriate non-surgical care. If the pain started suddenly with a pop or snap and you’re struggling to push off or stand on tiptoe, seek urgent medical assessment. Those symptoms can occur with an Achilles tendon rupture.
When should you book an assessment?
If you keep changing shoes to avoid the bump, or the pain is making you cut walks or runs short, an assessment can help you understand what’s being irritated and why. Bring the shoes that cause the most trouble, and any previous scans or reports you have
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Disclaimer: The word "treatment" in this article refers to the care and management of a patient’s health to prevent, cure, or improve a condition. Treatment results vary and do not necessarily indicate a cure. This article is for informational and educational purposes only and does not constitute medical advice.
About the Author
Mark B. Reyneker, BTech (Podiatry), MSc (Palaeontology) is a podiatrist and Founder & Clinical Director of Family Podiatry Centre, with more than 25 years of clinical experience across South Africa, Malaysia and Singapore. His clinical interests include foot and lower-limb pain, gait and biomechanics, sports-related foot conditions, orthotic therapy and footwear.
Alongside his clinical practice, Mark conducts research into human gait and foot biomechanics. His MSc research at the University of the Witwatersrand investigated human propulsion and the structural properties of the metatarsals. He is also the inventor of A Foot Orthotic, an orthotic technology developed through an international patent family.
References
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Available article: https://journals.sagepub.com/doi/10.1177/1071100717723127 - Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot & Ankle International. 2012;33(6):487–491. DOI
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Available article: https://www.proquest.com/openview/8064983244a1d78294a0a020487d2c5d/1?pq-origsite=gscholar&cbl=2041038 - Current concepts and management of insertional Achilles tendinopathy and calcific insertional Achilles tendinopathy. British Medical Bulletin. 2026;159(1):ldag031. DOI
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Frequently Asked Questions
It often feels like a hard bump at the upper back of the heel. When the tissues around it are irritated, the area may feel tender or appear swollen.
Yes. A prominent heel bone can be present without symptoms. An incidental finding on an X-ray is interpreted in the context of your symptoms and examination.
A Haglund prominence is the shape of the upper back of the heel bone. An insertional Achilles spur projects from the area where the tendon attaches. Both can be present in the same heel.
Haglund-related symptoms are felt at the back of the heel. Plantar fasciitis typically causes pain underneath the heel. Showing exactly where it hurts helps guide the examination.
Yes. A stiff or closely fitting shoe back can press on the area and irritate the tissues over the bump. If one pair consistently causes trouble, bring it to your assessment.
These activities load the Achilles tendon and can increase compression near its attachment as the ankle bends. Pain during these movements is a clue that the tendon may be involved.
Yes. The bony prominence can be present on both heels, and you may feel more irritation on one side.
Some cases can be assessed clinically. When imaging would help, an X-ray can show the shape of the bone, while ultrasound can help assess the tendon and bursa.
Yes. Symptoms can improve when pressure or irritation in the surrounding tissues settles. The bony contour can remain visible.
Care usually starts with non-surgical measures tailored to the tissue involved. Surgery is an option for selected cases with persistent symptoms after appropriate care.
