Pump bumps are painful, swollen bumps behind the heel, where the shoe rubs against the back of the ankle. It usually affects young women in their 20s and 30s who love to wear high heel shoes. The official name for this bump is Haglund's deformity, which is extra bone growing on the back of the heel bone. The soft tissue near the Achilles tendon becomes irritated when this bone rubs against shoes.
The rigid backs of pump-style shoes cause pressure that aggravates the enlargement when walking. The shape of the calcaneus (heel bone) and persons with high-arches, a tight Achilles tendon, and a tendency to walk on the outside of the heel, are at higher risk for developing a pump bump.
Haglund's deformity can occur in one or both feet. The primary symptom of Haglund's deformity is pain at the back of the heel, especially in the area where the Achilles tendon attaches to the heel bone. Over time the tissues over the boney bump thicken causing a callus to form. This area becomes inflamed while wearing shoes. The bursa on the back of the heel may become red, swollen and inflamed causing bursitis.
You can prevent Haglund's deformity by wearing appropriate shoes, avoiding shoes with a rigid heel back, using arch supports or orthotic devices recommended by the podiatrist, performing stretching exercises to prevent the Achilles tendon from getting tightened, and avoid running on hard surfaces and running uphill.

Diagnosis and treatments
The podiatrist will diagnose the problem starting with a complete history and physical examination. Usually the bump is obvious and easily seen on the back of the heel. X-rays will be taken so the podiatrist can see the shape of the calcaneus and to make sure there is no other cause for your heel pain.
Non-surgical treatment of Haglund's deformity is aimed at reducing the inflammation of the bursa. While these methods can help the pain and inflammation, they will not shrink the bony enlargement of the heel bone.
The primary cause of the problem is wearing shoes that press on the back of the heel. One easy way to remove the pressure from the back of the heel is to wear shoes with no back, such as clogs. If you must wear shoes with backs, heel pads placed over the back of the heel may give some relief. Staying out of shoes as much as possible will usually reduce the inflammation and the bursitis due to Haglund's deformity.
If the pain continues, see a podiatrist who will treat the condition. Oral non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to reduce the pain and inflammation. Ice can be applied to inflamed area to reduce swelling. Use ice for 20 minutes and then wait at least 40 minutes before icing again several times a day. Stretching exercises help relieve tension from the Achilles tendon and increase its flexibility. Heel lifts placed inside the shoe can also decrease the pressure on the heel. Ultrasound and other therapies can help to reduce inflammation. Insoles or orthotics (custom arch supports) help control the motion in the foot and relieve some pain.
If these strategies do not solve the problem, surgery may be needed. The surgical procedures designed to treat Haglund's deformity cut off a part of the heel bone to reduce the enlargement on the back of the heel. This will decrease the pressure from the shoe and prevent the pain. Over time, the thickened tissues will shrink back to near normal size if the pressure is removed.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996, or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport, Grand Bahama, telephone 373-7400.

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