Foot and ankle discomfort often presents as a painful enlargement at the back of the heel. This condition is widely known as a “pump bump” due to its frequent association with certain footwear styles. The pump bump is a noticeable, often tender bony prominence that develops on the heel bone, causing irritation and swelling.
What Causes the Pump Bump?
The medical term for a pump bump is Haglund’s deformity, involving an abnormality of the calcaneus, or heel bone. The condition is characterized by a bony protrusion, called an exostosis, located where the Achilles tendon attaches to the posterior calcaneus. This bony structure can press against the soft tissues and the Achilles tendon, especially when enclosed in a shoe with a stiff back.
Mechanical pressure from footwear with a rigid heel counter, such as dress shoes, ice skates, or pump-style shoes, is a primary factor in the irritation and growth of this prominence. This constant rubbing creates friction that aggravates the retrocalcaneal bursa, a small, fluid-filled sac between the Achilles tendon and the heel bone. The resulting inflammation of this sac is known as bursitis, which contributes to the pain and swelling.
Beyond external pressure, certain inherited foot structures predispose individuals to developing Haglund’s deformity. People with a high arch, or pes cavus, are more susceptible because the heel bone is often tilted backward, increasing the likelihood of the bony area rubbing against the shoe. A tight Achilles tendon can also increase the tension and pressure at its insertion point on the heel bone, compounding the irritation from footwear. Furthermore, a gait pattern that involves walking on the outside of the heel, or supination, can contribute to the development of this bony enlargement.
Recognizing and Diagnosing the Condition
Identifying Haglund’s deformity typically begins with recognizing the physical signs and symptoms. A person will usually notice a visible, hard bump on the back of the heel, often accompanied by pain and localized swelling. The skin surrounding the bony prominence may also display redness or develop a painful blister or callus where the shoe material rubs against the area.
Pain often worsens when wearing shoes that enclose the heel, and the discomfort is frequently linked to the associated bursitis in the area. A physical examination by a medical professional will confirm the presence of the enlarged bone and assess the extent of the surrounding soft tissue inflammation. To definitively diagnose Haglund’s deformity and rule out other causes of heel pain, X-rays are typically ordered. These imaging studies allow the doctor to visualize the structure of the calcaneus and measure the degree of the bony prominence, confirming the condition.
Treatment and Prevention Strategies
The initial approach to managing Haglund’s deformity focuses on conservative, non-surgical methods aimed at reducing inflammation and relieving mechanical pressure. Immediate measures often include the application of ice to the swollen area and the use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and swelling. Modifying footwear is a straightforward and effective step, which involves switching to open-back shoes or those with soft, flexible heel counters to eliminate friction on the bump.
Inside the shoe, a heel pad or heel lift can be placed to cushion the area and slightly elevate the heel, which may alter the angle of the calcaneus and reduce pressure. For individuals with underlying biomechanical issues like a high arch or excessive supination, custom-made orthotic devices are beneficial. These specialized inserts help control the motion of the foot and provide support, which can decrease the stress placed on the heel bone.
Physical therapy, including specific stretching exercises for the Achilles tendon, can help alleviate tension in the area. If conservative treatments do not provide adequate relief after several months, a surgical procedure may be considered. Surgery typically involves removing the excess bone from the calcaneus to smooth the area and eliminate the mechanical conflict with the Achilles tendon and bursa.
Preventing the development or recurrence of a pump bump centers on making thoughtful choices about footwear. Individuals prone to the condition should avoid shoes with rigid, unyielding backs, as friction is the primary trigger. Consistent use of orthotics and regular Achilles tendon stretching, as described in the treatment phase, are also key strategies for long-term prevention.