Pump bump, or Haglund's disease, is a bony enlargement that develops at the back of the heel, where the Achilles tendon attaches to the heel bone (calcaneus). This condition occurs due to repeated pressure and friction, often aggravated by wearing stiff-backed shoes like high heels, which is why it is commonly referred to as "pump bump." The constant irritation leads to inflammation of the surrounding soft tissues especially Achilles tendon and bursa, a fluid-filled sac that cushions the Achilles tendon. Over time, this can result in persistent pain, swelling, and discomfort, making it difficult to wear certain types of footwear.
Haglund's disease is primarily caused by excessive pressure on the back of the heel, often due to tight gastrocnemeus(calf muscle) poor footwear choices or structural foot abnormalities. People with low exercises or anatomical variants like high-arched or low-arched feet may be more prone to developing this condition because of the altered pressure distribution on the heel. Additionally, repetitive activities such as running, walking, or prolonged standing can contribute to its onset. As the heel bone experiences repeated stress, the body responds by forming extra bone tissue, inside the tendon and outside it leading to the characteristic bump. Over time, inflammation of the bursa (bursitis) can develop, causing increased pain and tenderness in the affected area.
The symptoms of Haglund's disease develop gradually and worsen over time. A noticeable bony bump at the back of the heel is the most common sign. Pain and tenderness are often felt, especially when wearing shoes that press against the bump. The affected area may also become red, swollen, and inflamed. Initially, discomfort may only be present when wearing specific shoes, but if left untreated, the pain can persist even when barefoot. In severe cases, stiffness in the Achilles tendon may occur, making it difficult to walk comfortably.
Mild cases of Haglund's disease is often be managed with proper calf stretching exercises, self-care and lifestyle modifications. Wearing soft-backed shoes or cushioned inserts can help reduce pressure on the heel. Applying ice packs can alleviate swelling and inflammation in acute episodes. Gentle calf muscle stretching exercises for the Achilles tendon and calf muscles can help relieve tension.If pain persists and if symptoms do not improve despite these measures, professional medical advice should be sought.
If self-care measures fail to provide relief or if the pain becomes severe, consulting a Foot and Ankle Orthopaedic Surgeon is recommended. Professional evaluation is necessary if the bump continues to grow, causing increasing discomfort, or if walking becomes difficult due to persistent heel pain. A thorough clinical examination, including imaging tests such as X-rays or MRIs, may be required to determine the extent of the condition and rule out other possible heel disorders.
Non-surgical treatment is the first line of management for Haglund's disease. Physical therapy, including stretching exercises and ultrasound therapy, can help reduce inflammation and improve mobility. Custom orthotic shoe inserts may correct foot alignment and relieve pressure on the heel. If conservative treatments do not provide sufficient relief, surgical intervention may be considered.
The procedure typically involves removing the excess bone growth at the back of the heel to reduce irritation. If bursitis is present, the inflamed bursa may also be removed. In cases where the Achilles tendon is under excessive tension, a partial release or lengthening of the tendon may be necessary. Most patients experience significant improvement after recovery. Post-surgical rehabilitation, including stretching exercises and gradual return to activity, is essential for optimal healing.
After treatment, it may be necessary to avoid rigid-backed shoes or high heels, particularly if they contributed to the development of the condition. Switching to well-cushioned, supportive footwear can help prevent recurrence. With proper foot care, stretching exercises, and appropriate footwear choices, most individuals can return to their normal activities without major restrictions.