Haglund's Deformity - Pump Bump

How to Treat that Painful Bump on the Back of the Heel

A skier's torn up heels. Credit: Heath Korvola/Getty Images

Haglund's deformity is a seldom-heard term for a prominent bone at the posterior (back) of the heel bone. The bump created by the bone often results in an irritated, red area that flares up occasionally, causing localized pain and swelling on the heel. A Haglund's deformity is also called a pump bump, because the condition often occurs in women and is aggravated by certain shoe styles, such as pumps or high heels.

The bone where a pump bump occurs is the calcaneus, or heel bone. The bump is usually due to an abnormality in foot function or bone position that creates shoe friction around the natural bone prominence at the back of the calcaneus. Genetics may also predispose people to the condition. It results in skin irritation that leaves a characteristic red bump, and can be quite painful.

Constant friction at the back of the heel can also irritate skin, causing changes such as redness, thickening, and increased skin lines.

Bursitis from Haglund's Deformity

Pain and swelling may be a sign of deeper inflammation, known as bursitis. Bursitis is inflammation of a fluid-filled sac (bursa) which serves to cushion a tendon against bone. A common form of bursitis in the ankle area, known as retrocalcaneal bursitis, can sometimes occur with a pump bump. An inflamed bursa can also develop between the skin and the Achilles tendon, causing swelling and tenderness to the touch.

Achilles Tendonitis

Haglund's deformity is sometimes associated with Achilles tendonitis. Symptoms of Achilles tendonitis, such as pain and swelling, usually occur a few centimeters above the area where the tendon attaches to the back of the heel. Over time, chronic injury to the Achilles tendon can cause it to weaken and break down, a condition known as tendonosis.

Treatment of Haglund's Deformity - Pump Bump

When a pump bump becomes inflamed, the most important part of treatment is to reduce pressure and friction at the site of the bump. The best way to do this is to ensure that you are wearing a shoe that fits well, and offers adequate support. Usually, shoes that are a bad fit are to blame. Some examples of how shoes can contribute to pain and irritation include:

  • The shoe style does not offer enough support, allowing the foot to slide around. Dress shoes or loafers are styles in which this can be a problem.
  • The heel counter (rear) of the shoe is too stiff or poorly designed, so friction is created at the heel when walking.
  • Shoes are the wrong size, either too tight or too loose.
  • Athletic shoes such as cleats are designed to be stiff, which can sometimes aggravate a pump bump.

Store-bought moleskin padding, or heel cups, can help by protecting the back of the heel from rubbing against the shoe. A store-bought arch support or custom-made foot orthotics can help to offset any foot biomechanical problems that contribute to a Haglund's deformity.

These products also help to hold the foot more securely in the shoe, which keeps the foot from slipping around.

Podiatric Help for Haglund's Deformity

Podiatric care of Haglund's deformity may involve identifying any biomechanical problems that are causing the problem. If bursitis is present, treatment may include anti-inflammatory medications or a corticosteroid injection to ease inflammation. Heel lifts or orthotics may be recommended to reduce tension on the Achilles tendon. Padding of the heel and shoe recommendations may also be a part of the treatment plan.

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