Wearing high fashion shoes, such as stilettos or pumps, can cause pain in your feet. If this is the case you could have a pump bump.
Pump bumps are painful, swollen bumps behind the heel, just where the shoe rubs against the back of the ankle. They are more common in young women in their 20s and 30s, who love to wear high-heeled shoes. The official name for this bump is Haglund's deformity; it is an extra bone growing on the back of the heel bone. The soft tissue near the Achilles tendon (heel cord) becomes irritated when this bone rubs against shoes.
The rigid backs of pump-style shoes cause pressure that irritates the area when walking. 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. The shape of the calcaneus (heel bone) can also cause this condition.
Haglund's deformity can occur in one or both feet. Most persons with this condition complain of 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 bony bump thicken, causing a callus to form. The area becomes inflamed while wearing shoes. The bursa on the back of the heel may also become red, swollen and inflamed, causing bursitis.
Prevention
You can prevent a pump bump by wearing appropriate shoes and avoiding shoes that are hard in the back of the heel, using arch supports or orthotic devices to raise the heel above this part of the shoe, performing stretching exercises to prevent the Achilles tendon from getting too tight and avoiding walking in your bare feet, running on hard surfaces and uphill.
Diagnosis
The podiatrist will diagnose the problem starting with a complete history and physical examination. Usually the bump is obvious and is easily seen on the back of the heel. X-rays will be taken so the podiatrist can see the shape of the calcaneus (heel bone) and to make sure there is no other cause for your heel pain.
Non-surgical treatment
Non-surgical treatment of a pump bump is aimed at reducing the pain and inflammation of the bursa. While these methods can help the pain and inflammation, they will not shrink the bony enlargement of the heel bone. One easy way to remove the pressure from the backs of the heel is to wear sling-back shoes, or shoes completely without backs, such as clogs. If you must wear shoes with backs, heel pads placed over the backs of the heel may provide cushioning and give some relief. Going without shoes as much as possible will usually reduce the inflammation and the bursitis.
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 the inflamed area to reduce swelling. Use ice for 20 minutes and then wait at least 40 minutes to an hour before icing again several times a day. Stretching exercises are vital and help relieve pulling 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.
Surgical treatment
If non-surgical treatments do not solve the problem and relieve symptoms, surgery may be needed. The surgical procedures designed to treat Haglund's deformity will shave or cut off a part of the enlargement to the heel bone. This will decrease the pressure from the shoe and prevent the pain. Over time, the thickened tissues will shrink back to near-normal size because the pressure has been removed.
o For more information on pump bumps, email foothealth242@gmail.com or visit www.orthogate.org or www.foothealthfacts.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates on Albury Lane, telephone 394-5820.

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