Haglund’s Deformity

Last updated: July 6, 2026Reviewed date: July 6, 2026Reading time: 3 min read

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Article Summary

Haglund's deformity is an abnormality of the bone and soft tissues in the foot. An enlargement of the bony section of the heel (where the Achilles tendon is inserted) triggers this condition. The soft tissue near the back of the heel can become irritated when the large, bony lump rubs against rigid shoes. Pathophysiology General Typically affects middle aged females Often bilateral Diagnosis is a combination...

Key Takeaways

This article explains Pathophysiology in simple medical language.
This article explains Causes in simple medical language.
This article explains Differential Diagnosis in simple medical language.
This article explains Diagnosis in simple medical language.

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Educational health guideWritten for patient understanding and clinical awareness.

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Emergency safety firstUrgent warning signs are highlighted below.

Definition

Haglund’s deformity is an abnormality of the bone and soft tissues in the foot. An enlargement of the bony section of the heel (where the Achilles tendon is inserted) triggers this condition. The soft tissue near the back of the heel can become irritated when the large, bony lump rubs against rigid shoes.

Haglund's Deformity

Pathophysiology

General
- Typically affects middle aged females
- Often bilateral
- Diagnosis is a combination of clinical and radiographic assessment
Haglund’s Deformity
- Defined as a bony enlargement of the posterosuperior part of the Calcaneus at the attachment site of the Achilles Tendon
Haglund’s Syndrome
- Posterior heel pain, characterized by a painful soft tissue swelling at the level of the Achilles tendon insertion
Pump Bump
- Visible and palpable thickening of the soft tissues at the Achilles Tendon insertion

Causes

It is mostly an idiopathic condition, but several contributory factors like over-practice in runners, tight or poorly fitting shoes, or altered biomechanics of foot joints because of the dealigned subtalar joint may play a role [rx].

Pathophysiology is poorly understood
Generally considered to be an idiopathic condition
General
- Achilles tendon attaches to the back of the heel bone
- The uppermost portion of the back of the heel bone can rub against the tendon
- Soft tissues can get irritated when the posterior calcaneus rubs against the shoe
- This can lead to retrocalcaneal bursitis, Achilles tendonitis and subsequent thickening of the tendon

Runners
Tight or poorly fitting shoes
Altered biomechanics
- Tight Achilles Tendon or Posterior chain
- Walking on outside of heels

Differential Diagnosis

Fractures & Dislocations
- Distal Tibia Fracture
- Distal Fibular Fracture
- Talus Fracture
- Calcaneus Fracture
- Subtalar Dislocation
- Ankle Fracture (& Dislocation)
- Peroneal Subluxation
Muscle and Tendon Injuries
- Peroneal Tendon Injuries
- Achilles Tendonitis
- Achilles Tendon Rupture
- Posterior Tibial Tendon Dysfunction
- Flexor Hallucis Longus Tendinopathy
Ligament Injuries
- Lateral Ankle Sprain
- Medial Ankle Sprain
- Syndesmotic Sprain
- Chronic Ankle Instability
- Intersection Syndrome Foot
Bursopathies
- Retrocalcaneal Bursitis
Nerve Injuries
- Peroneal Nerve Injury
- Tarsal Tunnel Syndrome
Arthropathies
- Osteoarthritis of the Ankle
- Osteochondral Defect Talus
Pediatrics
- Fifth Metatarsal Apophysitis (Iselin’s Disease)
- Calcaneal Apophysitis (Sever’s Disease)
Other
- Haglunds Deformity
- Posterior Ankle Impingement Syndrome
- Sinus Tarsi Syndrome

Diagnosis

Clinical example of Haglund’s Deformity

History
- Characterized by retrocalcaneal heel or ankle pain
- Limping swelling may be present
- Pain worse at the initiation of walking or unning
Physical Exam: Physical Exam Ankle
- Prominent swelling and bump is noted over the back of both heels
- Warmth, redness, and tenderness may be present over the posterior heel
- Plantarflexion should be intact
Special Tests
- Thompson Test: should be normal

Radiographs

Standard Radiographs Ankle
- Sufficient to make the diagnosis
Potential Findings
- Haglund’s lesion: prominent calcaneal projection at posterosuperior part of the calcaneal tuberosity
- Calcaneal bursal swelling
- Increased density in pre-Achilles bursae
- Heterotopic bone formation at the insertion of or within the Achilles tendon
Fowler’s Angle: needs update

MRI

Not routinely required
- Can be obtained in equivocal cases
Potential findings
- Posterosuperior calcaneal spurring with impingement on the Achilles tendon
- Synovial thickening and collection in the retrocalcaneal bursa
- Thickening and high signal in the insertional fibers of Achilles tendon and
- Edema in the adjoining retro-Achilles fat pad

Haglund's Deformity

Treatment

Nonoperative

Indications
- Vast majority of patients
Goal
- Reduce symptoms, treat soft tissue swelling and pain
- This approach will not shrink the bony protrusion
Shoe inserts
- Altering heel height in shoe wear can offload the achilles
- Consider heel pads, lifts or wedges
Open heel shoes
- Wearing shoes that are backless or have soft backs will avoid or minimize irritation
Orthosis
Physical Therapy
- Stretching of posterior chain
NSAIDS
Topical Analgesics
Ice therapy
Corticosteroid Injection
- In select cases with ultrasound guidance to avoid injecting in Achilles Tendon
Additional therapies to consider (note: no current evidence to support)
- Therapeutic Ultrasound
- TENS

Operative

Indications
- Failure of conservative management
Technique
- Retrocalcaneal decompression
- Calcaneal ostectomy or osteotomy
- Calcaneoplasty

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

Write when the problem started and how it changed.
Bring old prescriptions, investigation reports, and current medicines.
Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

What is the most likely cause of my symptoms?
Which danger signs mean I should go to hospital quickly?
Which tests are necessary now, and which can wait?
How should I take medicines safely and what side effects should I watch for?
When should I come for follow-up?

Tests to discuss

Vital signs: temperature, pulse, blood pressure, oxygen saturation
Basic physical examination by a clinician
CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Rest, drink safe water, and observe symptoms carefully.
Keep a written note of symptoms, duration, temperature, medicines already taken, and allergy history.
Seek medical care quickly if symptoms are severe, worsening, or unusual for the patient.

OTC medicine safety

For mild pain or fever, ask a registered pharmacist or doctor before using common over-the-counter pain/fever medicines.
Do not combine multiple pain medicines without advice, especially if you have kidney disease, liver disease, stomach ulcer, asthma, pregnancy, or take blood thinners.
Do not give adult medicines to children unless a qualified clinician advises it.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Severe symptoms, confusion, fainting, breathing difficulty, chest pain, severe dehydration, or sudden weakness need urgent medical care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider

Tests to discuss with doctor

Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
Relevant blood, urine, imaging, or specialist tests only after clinical assessment

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Key Takeaways

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