Haglund deformity is a painful condition that arises when a prominent bony outgrowth at the back-upper corner of the heel bone (calcaneus) rubs against the Achilles tendon and the retrocalcaneal bursa. It is also known as a "pump bump" — a name that comes from the way high-heeled shoes with a stiff back edge press on this area and trigger the complaints. It is more common in women than in men and is often present in both feet.
The basis of the condition lies in the anatomy of the heel bone. In some people, the back surface of the calcaneus is naturally more prominent, and this outgrowth causes mechanical irritation at the point where the Achilles tendon contacts the bone. Over time, the bursa (fluid sac) between the tendon and bone becomes inflamed (retrocalcaneal bursitis), and degeneration begins on the surface of the Achilles tendon where it contacts the bone. If this degeneration is left untreated, the tendon weakens and the risk of a tear increases.
Typical symptoms are swelling, redness, and pain at the back of the heel that increases especially after putting on shoes. Pain becomes pronounced with climbing stairs, walking uphill, and running. On palpation there is tenderness over the outgrowth at the back of the heel. Diagnosis is made with a lateral (side-view) foot X-ray; MRI is requested to assess the extent of degeneration in the Achilles tendon.
Conservative treatment is the first step and controls symptoms in about sixty percent of patients. It consists of using a heel pad or silicone heel cup, shoes without a stiff back edge, ice application, anti-inflammatory medications, and eccentric Achilles tendon stretching exercises. If improvement is not achieved within six months despite these measures, surgical options are evaluated.
The goal of surgical treatment is to remove the prominent bony outgrowth and clean out the inflamed bursa. The endoscopic (closed) posterior approach has become the gold standard in recent years. Through two small incisions, a camera and a motorized shaver (burr) are placed behind the joint; the bony outgrowth is shaved and corrected, and the bursa is cleaned. Compared with open surgery, wound problems are far less common, recovery time is shorter, and the cosmetic result is superior.
After surgery, the patient walks for the first two weeks in a special boot or splint without putting pressure on the heel. From the second week, gradual weight bearing begins, and by the fourth week full weight is borne and normal walking resumes. Return to running is usually possible between the eighth and twelfth weeks. If there is degeneration in the Achilles tendon, the recovery period may extend a few weeks longer.
The success rate after surgery is above ninety percent. In cases that have been neglected for a long time and have developed significant Achilles tendon degeneration, additional tendon debridement or repair may be required. For this reason, patients who do not respond to conservative treatment are advised not to delay surgery too long — early intervention both reduces the scope of the operation and speeds recovery.