As smart and as safe as we try to be, life is always filled with occasional bumps and bruises. Most of them are temporary annoyances that clear up in a few days or weeks, but when one of those bumps appears at the back of your heel, you may find it difficult to wear shoes without pain. A noticeable bump in the back of the heel is often a sign of a condition known as Haglund’s deformity, also known as pump bump.
In addition to a noticeable bump, you may notice pain, redness, and swelling in the area where the Achilles tendon attaches to the heel.
Why Is There a Bump on the Back of My Heel?
There’s a reason the condition is known as “pump bump”: many cases can be traced back, at least in part, to wearing shoes with inflexible, rigid backs. Most pumps, of course, fit this description, although they’re not the only one—ice skates, men’s dress shoes, certain boots, and other types of footwear can create the same effect.
The problem is pressure and friction—the back of your heel rubs constantly against the hard back of the shoe, irritating the soft tissues and leading to both painful bursitis and an enlargement of the bony section of your heel.
Other underlying factors that can increase your risk include high arches, a tendency to walk on the outside of your heel (as with those who under-pronate), or a tight Achilles tendon. Overuse can also increase the amount of pressure on your heels—too much running on hard surfaces or uphill, for example.
Non-Surgical Treatment Options
First, some bad news: while conservative treatment can address the swelling and pain of soft tissues, any existing bone enlargement is permanent without surgery—in other words, you may always have a bit of a protrusion at the back of your heel.
The good news is that, despite this, conservative treatment is often effective at eliminating pain and stopping the progression of the bony growth, making surgical treatment unnecessary—we would not recommend it for purely cosmetic reasons.
Your treatment plan will be tailored to your needs. In most cases, a switch to soft-backed shoes is recommended, while cushioned heel pads, rest, medication (OTC anti-inflammatories, or prescription-strength versions if necessary), and ice can help you deal with the temporary pain and swelling of a flare-up. Several physical therapy techniques (including ultrasound) are also commonly employed.
Stretching exercises can be particularly beneficial for patients with an unusually tight Achilles tendon as a contributing factor, while shoe inserts like heel lifts or full custom orthotics can provide support and stability for those with foot deformities (such as high arches) that may also be a factor.
Surgery for Haglund’s Deformity
If painful symptoms persist despite less invasive attempts to alleviate them, surgery may be considered. Although surgery is usually highly successful, we still consider it a last resort, used only when alternatives are exhausted.
The primary goal is usually to remove the bony enlargement, which relieves pressure on the bursa and soft tissues; related issues, such as a degeneration in the Achilles tendon, may be addressed at the same time. Although the exact details of the procedure may vary based on your age, condition, and health status, often an incision is made on the inside of the heel next to the Achilles, through which prominent bone growth is removed.
It will be important to follow your doctor’s orders for post-op care very closely, especially if any tendon repair was conducted. This will help you recover faster and prevent complications or chronic problems.