The Heel Bump (Haglund's)
- David Tollafield
- Nov 5
- 6 min read
Updated: Nov 13
Self-help and Managing Heel Pain
In this article you will learn:
What is a heel bump.
The problems that arise.
The cause of the problem.
Self-help & first aid.
Brief overview of surgery.
The most common types of heel pain problems arise from general overuse or repetitive heel pad strain, but heel pain diagnosis can be complex. In this article I wanted to cover a condition known as 'pump bump', often Haglund's (after the Swedish surgeon, Patrik Haglund described this in 1927) or Mullholland deformity.
My interest in the condition extends to the fact that I have a Haglund's deformity on one foot, which only became obvious later in life. It is also referred to as retrocalcaneal exostosis. That simply means, behind the heel bone. While I have treated many heel conditions, some by surgery, I thought a personal take and self-help awareness would be useful.
Let's Avoid Surgery
If the pain does not subside with self-help remedies after several weeks, do seek professional medical help from a podiatrist or orthopaedic practitioner. The first point to make is that with care and guidance, you can avoid surgery. I will add a bit about surgery toward the end, but my main focus is conservative care.
No matter what bump exists on the foot, e.g bunion, tarsal bump and navicular, to mention three common sites. All bony projections (exostoses) can compress the skin against the shoe. There are several considerations:
Will the skin cope?
Is the shoe likely to make the problem worse, or will it stretch around the bump?
What type of changes arise because of the bump?
The Skin
Healthy skin can cope up to a point. Red skin is the first indication of the problem that leads to a blister. Callus may follow afterwards. After a walk you might find gnawing burning pain around the heel. If the walk is too long and you do nothing, then your heel may be very sore, bleed or show a thin leaky roof of a blister, which at worst sloughs off and leaves the skin raw.
Patients who have poor circulation and dampened nerves (neuropathy), thin skin, reduced fat padding, are prone to more damage.
The Shoe
The 'pump or shoe bump' comes from the heel being stiff and rubbing the skin. Look inside the shoe and if you see the lining wearing away, this clearly means the shoe has adapted to the bone projection. However, when new, the shoe may damage the skin.
The Changes
The redness, blister and soreness are one thig, but in winter and cold damp spells, the heel bump is a target for chilling or chillblains.
Deeper inside the foot, the bone may be surrounded by a bursa, an organised fluid filled sac. This is like a skin blister, but exists deeper. An active bursa causes swelling in an effort to calm the area from pressure. There is another problem. If the patient has poor quality skin, or a medical condition that leads to healing problems, ulceration can arise, which then fails to heal because it is continuously rubbed.
As the bump increases, because of a bursitis (inflamed bursa), more bone is laid down, like the concentric rings of a tree adds to its diameter. Once enlarged, shoe problems become very inconvenient.
What Causes a Heel Bump?
The heel bump alliance to our DNA sounds plausable. The argument suggesting a trend for bump formation relates to families, but it may also be associated with other familial traits.
The back of the heel is made from two developmental centres that grow together (foot growth - Primary Source Royal Free London Hospital. Accessed Nov.2025).
The secondary centre (arrow) is small and joins the main heel bone (calcaneus) around adolescence. Some children develop pain at this point called apophysitis or Sever's disease. The latter term is not a disease.
The difficult part to understand is the relationship between these two areas of bone.
The secondary centre may twist
Twisting or torsion arises in some people arises, so the back of the heel may not align and develops at an angle. The heel bone may be inverted—called varus. This type of foot development is open to more pressure in a shoe than those with a level heel. The same problem can be seen in the high arched foot (pes cavus) where the back of the heel is inverted.
The second cause, which is less of a hereditary condition, arises when the heel twists in the shoe because of movement against the inside heel. The bone lining called periosteum is irritated and new bone is laid down at the point of repetitive pressure. This process concludes with laying bone so it enlarges and in so doing, adds more pressure.
The heel bump does not appear to cause problems before adolescence, lending the argument to the natural variations around fusion.
The two approaches to conservative treatment are therefore:
Reduce foot movement.
Reduce pressure build up.
How? ....
Foot movement can be reduced by placing a controlling device inside the shoe with a heel cup to stabilise the foot. This is called an orthosis. The foot orthosis is valuable if symptoms have not developed, but if the bump is inflammed and tender then you will have to reduce pressure.
The best protection can be created by placing a friction resistant material between the skin and shoe. The gel sleeve (below) is my go to. It allows direct control. Does not require to be adhered to the foot, and it is thin and comfortable.
My preferred tip is to ensure a good fit at the time of purchase. Try the shoe in house for 30 minutes.
Check before leaving the shop (unless purchased on line) that there are no points that will add to the pressure. Herein lies a problem with shoe purchase. It may take 30 minutes of wear before you realise the shoe(s) may not be the best design for your bump. Even softer shoes can rub.
If a regular shoes still rubs, try a foam heel pad. These are readily available on-line and come in packs of several pads so you can spread them around shoes that cause irritation. I now have these fitted to all my shoes where I know they will rub.
First Aid
If the skin is red and sore, apply a blister dressing. These are available from high-street pharmacies, often with their foot care products. Made from a thin gel, they cushion and are water-resistant and worth carrying in a bag or rucsac.
Blister roof open or sloughing. Don't use the above because you will need to provide a soothing antiseptic cream and gauze secured with Micropore or similar. Wash the wound if seeping with cooled hot sterile water or normal saline solution (sterile sachet) or chlorhexidine sachet.
Wear open heel sandals or similar to allow no pressure, until healed.
Steroid injections
Some clinicians will offer steroid in injections, but this should only be used for a bursal swelling. The skin is thin and will be damaged by steroid unless the medication is placed deep into the fluid sac. I would only allow one injection in this case.
Surgery
I'm not a big fan of heel surgery, but then needs must and there are reasons why surgery is a good decision.
Unremitting pain.
Constant foot fit problems.
Recurrent skin breakdown & infection.
Deeper changes with chronic bursa formation.
The incision line must be to the side and allowed to heal with care over scar tissue. A central scar line will become irritated by the shoe.
Larger surgery may require bone to be cut (osteotomy) with achilles tendon involvement. This is big surgery and recovery can be longer than just resecting the ridge of bone, where the tendon is not involved.
Thanks for reading about the heel bump (Haglund's). I have added some reliable references for surgery and more about the condition, but it is always best to consult a specialist foot surgeon.
Foot Education Article 2024 (contains some adverts).
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