Haglund’s Deformity: Pump Bump

If you wear high heels frequently and experience pain in the back of the heel—particularly if it’s accompanied by localized swelling—you likely have a case of Haglund’s deformity. Also known as “pump bump,” this condition is definitely one reason you should at least consider limiting how often you wear high-heeled shoes (even if those pumps are “super cute”).

Choosing the wrong footwear is akin to marrying the wrong person – things might be okay at first, but they can (and likely will) become intolerable over time. A case of pump bump slowly develops but can still be addressed no matter how long you have had it.

pile of differently colored high heel shoes

What is Haglund’s Deformity?

As noted above, this is a medical condition that causes pain and the formation (and enlargement) of a bony bump in the back of the heel. The bump itself might not cause issues when there is no pressure placed upon it, but while wearing shoes that have a curved and rigid backing or heel straps (as many pumps and stilettos do). A war starts between the shoe and the back of your heel.

Other symptoms of Haglund’s deformity include swelling and redness. When you switch to lower-heeled shoes, there may be a reduction in the swelling, although the Achilles tendon is then pulled tightly and can be a source of pain.

Some people are under the false impression that a bone spur on the bottom of the heel is a major concern, but this is simply not the case. You certainly can develop a heel spur on the underside of your foot, you have enough padding in the area to reduce the odds of having pain because. If you think about the back of your foot—reach down there to feel—you will realize there is not any padding. Instead, it is already rather boney, and this explains why a pump bump tends to be considerably more of an issue than a heel spur on the bottom of the calcaneus.

As is the case with some other medical issues, one problem can lead to another. With time and chronic inflammation, a pump bump will cause bursitis.

In between the heel bone and Achilles tendon, there is a fluid-filled sac known as a bursa. Its function is to provide cushioning and act as a lubricant so the Achilles can more easily slide. When a pump bump pushes into the bursa, this sac becomes inflamed and swollen, causing pain and redness. That is bursitis.

How is Haglund’s Deformity Treated?

In addition to relieving pain and inflammation in the back of the heel, another goal for treatment is to prevent long-term damage to the Achilles tendon (which can develop in the 5th or 6th decade of life). As always, treatment comes down to either changing the environment (stretching) or changing the foot (surgery). Surgery is typically reserved for the end stage and is the patient’s choice when the limitations and pain can no longer be tolerated.

With regard to “change the environment” treatment, you will find ice to be your best friend for finding temporary relief. In addition to addressing the pain, an icing regimen will also reduce swelling in the area. Another option we may recommend is using a stretching boot. With this option, you take the boot home and use it for a minimum of an hour a day. This serves to stretch your Achilles complex and reduce issues that develop when the tendon is too tight.

We briefly touched on this earlier, but suddenly going from high-heeled footwear to those with low heels can be a problem. This is attributed to changes in the Achilles tendon from the elevated position in the high-heeled shoes that allow the soft tissue to tighten and shrink. Maintaining flexibility with calf stretches is particularly beneficial.

When conservative care does not produce the results you want, Dr. Leibovitz may recommend a surgical procedure to resolve the problem and provide optimal relief. These surgeries usually entail removing the excess bone tissue causing the problem, smoothing down the attachment surface, and lengthening the Achilles complex. If you wish to pursue this treatment option, we will discuss your procedure in detail so you know exactly what to expect.

Can a Pump Bump Be Prevented?

The painful symptoms may bring you in to our office for treatment, but there are prevention methods that can help you avoid the condition. These start with your choices in footwear. Always limit the amount of time you spend wearing high-heeled shoes, like pumps and stilettos. You do not necessarily have to avoid them completely, but try to save your stylish footwear for special events.

In addition to limiting how often you wear high heels, another important preventative measure is to use a regular stretching regimen. Dr. Leibovitz can recommend specific stretches that will appropriately target your Achilles tendon.

A definite risk with this condition includes skin being rubbed off when the pump bump gets too big and you continue wearing high-heeled shoes with stiff backs. Something you may wish to consider—particularly if you aren’t keen on the idea of ditching high heels altogether—is to choose footwear like pumps without heels.

WARNING!! This is a NO INJECTION ZONE. A steroid added to this area will weaken the tendon and increase the risk of tearing.

Professional Treatment for Haglund’s Deformity

When you have pain in the back of the heel, be sure to come see your go-to foot doc. Dr. Leibovitz will carefully evaluate your situation, give you an accurate diagnosis and create an effective treatment plan to eliminate painful symptoms and care for the condition.

Follow the lead of your neighbors who already make our office their first choice for foot and ankle care and contact us today. Schedule your appointment with our Indianapolis, IN foot doctor office by calling (317) 545-0505.