This condition is otherwise termed “Haglund’s deformity” or “Pump bump”. Typically, there is a hard (bony) lump at the back of the heel, which causes discomfort with shoes. The skin over the bump becomes red and tender, and may even blister and break down.

The condition is caused by a bony prominence on the heel-bone (calcaneum), and this in itself can cause further problems by “impinging” on the Achilles tendon, leading to marked swelling or “retro-calcaneal bursitis” and degeneration of the tendon itself.

Often the symptoms settle with simple measures, such as shoe modification, rest specialised padded appliances. Sometimes a podiatrist can help with a custom-made insole, and occasionally an injection is indicated for retro-calcaneal bursitis (although not into the tendon itself).

If these measures fail, surgery is required, and involves removal of the retro-calcaneal bursa and prominent bone, along with any degenerate tendon tissue. This is called a Haglund’s excision operation, and in some cases can be done endoscopically, using keyhole surgery. The success rate of surgery is 85 – 90%.