Pump Bump

May 3, 2006 The Achilles tendon is a piece of tissue that connects muscle to bone. The Achilles tendon is the long tendon that connects the calf muscle to the heel bone. It is also known as the "heel" cord. When we walk, the Achilles tendon helps to raise the heel off the ground. Sometimes the Achilles tendon can become inflamed (called Achilles tendonitis). The condition can be caused by constant or repetitive pressure on the back of the heel, which injures the fibers in the tendon. Patients may experience pain and tenderness in the area of the heel or at any point along the tendon (such as the area just below the calf muscle). Pump Bump Pump bump (also known as Haglunds deformity) is a bony enlargement on the back of heel. It occurs when the heel of the foot is subjected to irritation or pressure (like that from a shoe), causing microscopic injury to the area. The body reacts to the microtrauma by producing extra bone. A fluid-filled sac (called a bursa) develops on the top of the bump to protect the bone. Over time, pressure from walking aggravates the area, causing inflammation, swelling, redness and pain where the Achilles tendon attaches to the heel. In severe cases, patients may be unable to wear a shoe. Pump bump is common in women who frequently wear high-heeled shoes. The height of the shoe puts extra pressure on the heel. Its also common in soccer and hockey players (from the cleats and rigid skate blades). People with high arches, a tight Achilles tendon and a tendency to walk on the outside of the heel are more prone to developing pump bump. Treating Pump Bump Most cases of pump bump get better with conservative treatment. Anti-inflammatory medication and application of ice can help reduce pain and swelling. Stretching exercises may help reduce some tightness in the Achilles tendon. People with high arches may benefit from a heel lift placed inside the shoe. Heel pads may also reduce irritation while walking. The best way to treat/prevent pump bump is to avoid wearing high-heeled shoes. Marybeth Crane, D.P.M., a Podiatric Surgeon, says women who need to wear high-heeled shoes should look for footwear with a wide, chunky heel, rubber soles for cushioning, a flexible forefoot and a padded back. Some high heels come with built-in arch supports, which may be good for women with high arches. AUDIENCE INQUIRY For information about pump bump (Haglunds deformity): American Academy of Orthopaedic Surgeons, public website, http://orthoinfo.aaos.org American College of Foot and Ankle Surgeons, http://www.footphysicians.com American Podiatric Medical Association, http://www.apma.org BIBLIOGRAPHY "Achilles Tendon," Rosemont: American Academy of Orthopaedic Surgeons, downloaded from public website (http://orthoinfo.aaos.org), March 27, 2006. "Achilles Tendon Disorders," Chicago: American College of Foot and Ankle Surgeons, downloaded from website (http://www.footphysicians.com), March 27, 2006. Aronow, Michael, M.D., "Posterior Heel Pain (Retrocalcaneal Bursitis, Insertional and Noninsertional Achilles Tendinopathy," Clinics in Podiatric Medicine and Surgery, January 2005, Vol. 22, No. 1, pp. 19-43. "Haglunds Deformity," Chicago: American College of Foot and Ankle Surgeons, downloaded from website (http://www.footphysicians.com), March 27, 2006. "Heel Pain," Bethesda: American Podiatric Medical Association, downloaded from website (http://www.apma.org), March 27, 2006. "Heel Pain," Rosemont: American Academy of Orthopaedic Surgeons, downloaded from public website (http://orthoinfo.aaos.org), March 27, 2006. Sammarco, G. James, M.D., et al., "Operative Management of Haglunds Deformity in the Nonathlete," Foot and Ankle International, November 1998, Vol. 19, No. 11, pp. 724-729. Schneider, Wolfgang, M.D., et al., "Haglunds Syndrome," Foot and Ankle International, January 2000, Vol. 21, No.1 , pp. 26-30. Sella, E., et al., "Haglunds Syndrome," Journal of Foot and Ankle Surgery, March-April 1998, Vol. 37, No. 2, pp. 110-114. "Still Think High Heels are Worth It?" Chicago: American College of Foot and Ankle Surgeons, downloaded from website (http://www.footphysicians.com), March 27, 2006. Yodlowski, Marilyn, M.D., Ph.D., et al., "Surgical Treatment of Achilles Tendonitis by Decompression of the Retrocalcaneal Bursa and the Superior Calcaneal Tuberosity," The American Journal of Sports Medicine, May-June 2002, Vol. 30, No. 3, pp. 318-321. Yung-Hui, L., and H. Wei-Hsien, "Effects of Shoe Inserts and Heel Height on Foot Pressure, Impact Force, and Perceived Comfort During Walking," Applied Ergonomics, May 2005, Vol. 36, No. 3, pp. 355-362. Research compiled and edited by Barbara J. Fister