Understanding and Managing Pump Bump

Last updated on March 9th, 2024 at 03:08 pm

Pump bump, also known as Haglund’s deformity, is a painful condition affecting the posterior heel. It is caused by rigid hardback shoes rubbing against the bony protrusion on the back of the heel, resulting in pain, inflammation and discomfort. Understanding and managing pump bump is crucial for maintaining foot health and wearing your favourite shoes. This article will provide a comprehensive guide to understanding and managing pump bumps, including causes, symptoms, diagnosis, and treatment options. Whether you are suffering from a pump bump for the first time or have been dealing with it for years, this guide will provide valuable information and tips for managing the condition. Read on!

Causes of pump bump

The scientific name for pump bump is retrocalcaneal exostosis, and Patrick Haglund first introduced it in 1927. It s important to know that condition is still poorly understood and often idiopathic (cause unknown). The causes of pump bumps vary, but the most common ones include wearing rigid back shoes, high heels, high arch, overuse, tight Achilles tendon, ill-fitting shoes and heredity. It primarily affects middle-aged females, but men can develop the condition too. It is bilateral in nature, meaning both heels are generally affected. Clinically, the pain is felt in the back of the heel, and it’s worse after a period of rest.

Symptoms

According to Vaishya et al (2016), Haglund’s deformity can cause various symptoms. One of the most common symptoms is pain and discomfort in the posterior heel area (pain in the back of the heel), which can be felt when standing, walking, or wearing shoes. Swelling and redness in the heel area are also common, as is difficulty walking or standing for extended periods. Bruising or calluses may also develop on the heel due to the condition. In addition to these symptoms, the deformity also causes changes in the shape of the heel bone, leading to a noticeable bump (Haglund’s lesion and calcification of the Achilles tendon). Calcaneal bursitis and Achilles tendinopathy are often present with Haglund’s deformity. If left untreated, pump bump can lead to chronic pain and inflammation in the heel area, making it difficult to perform everyday activities.

Diagnosis

The diagnosis of a pump bump typically begins with a physical examination, where the podiatrist or another care provider looks for signs of pain, swelling, warmth and redness in the affected area. They may also request an X-ray to confirm the presence of a bony spur or intra-tendineal calcification. Additional tests, such as an MRI or ultrasound, may be used to assess the condition of the surrounding soft tissue. It is essential to determine whether inflammation is present anterior or posterior to the Achilles tendon to rule out retro Achilles and retrocalcaneal bursitis.

Differential diagnosis

Careful examination and palpation of the surrounding tissue are critical to differentiate Haglund’s deformity from insertional Achilles tendinopathy, calcaneal bursitis, os trigonum syndrome, posterior malleolus fracture and avulsion of the Achilles tendon. With insertional Achilles tendinopathy, pain is felt when the insertion point into the calcaneus is palpated. Calcaneal bursitis can be differentiated by palpating either of the Achilles tendon for pain. Os trigonum can be diagnosed by pointing the toe to elicit pinching and pain in the back of the ankle. Posterior malleolus fractures are rare and often accompanied by more complex pathologies, and pain will be felt above the heel.

Treatment

Conservative treatment options work well in most cases of pump bump. These include rest, ice, NSAIDs like ibuprofen (topical gel or oral), footwear advice such as avoiding high heels and rigid back shoes, heel lifts, cushioning pads and, in some cases, orthotics. Physiotherapy may be indicated to address any tightness in the calves muscles. Also, it is not unusual for corticosteroids injection to be administered. However, caution must be exercised to reduce the risk of Achilles tendon rupture. In recalcitrant cases, surgery may be necessary to remove the bony protrusion. Surgery typically involves calcaneal osteotomy and retrocalcaneal decompression. Expect to be in a cast for a couple of weeks, followed by rehabilitation.

Recovery time varies from 3-6 months, and there is no guarantee that fashion shoes will be worn comfortably after. Surgery does not come without risks and it is possible that one could have ankle stiffness, Achilles tendon avulsion, damaged nerves, persistent heel pain, problems with wound healing, infection and scarring after the procedure.

Prevention tips

Preventative measures are essential to avoid a pump bump or prevent it from getting worse. This includes choosing shoes with a wider heel counter, reduced heel height and a rocker bottom. Careful and proper stretching calf exercises will be of immense benefit. Additionally, try to keep your training load manageable; if you exercise on uneven surfaces or terrain, ensure you have the appropriate footwear.

Prognosis of pump bump

The prognosis for pump bump is generally good with appropriate treatment. In most cases, conservative treatments will do, but surgery may sometimes be required. Recovery times vary depending on the severity of the condition and the type of treatment received. With proper treatment and management, most people with Haglund’s deformity are able to achieve pain-free mobility and return to their normal activities.

Question your doctor may ask you about your pump bump

When did you first notice the bump on the back of your heel?
Have you had any previous injuries to the heel or ankle?
Do you engage in any physical activities that may have caused or contributed to the condition?
Have you noticed any changes in the way you walk or run?
Have you tried to self-treat?
Are you experiencing any other symptoms?
How long have you had the deformity?
Do you have any other medical conditions?
Have you noticed any changes in the shape or size of the bump over time?
Are you experiencing difficulty performing your daily activities due to Haglund’s deformity?

Questions you can ask your clinician about pump bump

Can Haglund’s syndrome be prevented?
Are there any surgical options for treating Haglund’s syndrome?
How long does it typically take for symptoms to improve with treatment?
Can Haglund’s syndrome reoccur after treatment?
Are there any alternative treatments for Haglund’s syndrome?
Is it safe to continue playing sports or other physical activities while I have Haglund’s syndrome?
Can Haglund’s syndrome affect both feet or just one?

Final thoughts

Incorporating the tips mentioned earlier will help you avoid getting a pump bump and help with fixing the problem, thus alleviating heel pain. Poor footwear is one of the major contributors to this problem. Consider using a shoe with a soft back and appropriate heel height. It is important to seek medical advice to determine the cause of the condition and provide appropriate treatment options. Remember, your health is your wealth! Seek help!