It sounds like a catchy lyric from the Black Eye Peas or Beyonce, but “Pump Bump” is a common term used among podiatric physicians. Do you have pain behind your heel? Do shoes irritate areas behind your heel and cause pain? Do you feel an abnormal bump behind your heel? It may be a bump that is irritated by your pump and thus a pump bump!
Pump Bump may also be referred to as a Haglund’s deformity as well as a retrocalcaneal bursitis. Typically, women most commonly complain of the irritation due to their selected shoes designed for fashion rather than comfort. The pain is sharp and along the side of the Achilles tendon insertion into the heel. Many of my patients find significant relief when they wear athletic shoes or backless shoes, but additional treatment is often needed to be completely pain free.
Typically a pump bump is caused by some abnormality in the heel bone. It may be that the heel bone tilts slightly out or pronates. Or, the heel bone may be tilted upward in a high arch. The Achilles tendon is only attached to the middle one-third of the heel bone. The upper one-third of the heel normally allows a nice gliding motion of the tendon like a pulley. When the heel bone is mal-positioned, the gliding motion is less smooth. Eventually, the unusual rubbing of the Achilles tendon causes irritation and the body develops a bursa. The bursa then becomes inflamed and causes pain in the heel.
On examination, the back of the heel will appear red, slightly swollen and painful to the touch. X-rays or ultrasound will often reveal some degree of boney deformity or mechanical disruption.
When changing shoes does not resolve the painful symptoms, it is necessary to see a podiatric physician to begin a treatment regimen that will hopefully keep you out of surgery. A heel lift can be put in the shoe. This will elevate the heel and reduce the area of friction on the shoe. NSAIDs are also used to decrease the inflammation, but it should be noted that if the shoe is still rubbing hard up against the bump the drugs will not be of great effect. Some of my patients have seen great relief by stretching their Achilles tendon 2-3 times a day. In addition, cryosurgery, which is a minimally invasive procedure helps relieve the inflammation along the heel. In most cases, the pain at the back of the heel is due to the constant pulling of the Achilles tendon along a sack of tissue in this area. This is called bursitis. Cryosurgery requires a very small incision along the area and then a probe that sends liquid nitrous oxide at a temperature of (-) 72 degrees is placed into the inflamed area. This reduces the inflammation, thus relieving the pain permanently. One can walk right away after the procedure with their regular sneakers.
Depending on the cause of your bump, orthoses may be necessary to correct the mechanical problem of your heel. Sometimes, the bump is unable to be resolved by the treatments and surgical excision of the bone bump is necessary.
Wednesday, October 28, 2009
Children Get Heel Pain Too and They are Not Faking IT!
Many of us think that foot problems are one of the aches and pains of aging. But heel pain is not normal nor is it isolated to only adults. I have seen my share fair of children and teens that are having difficulty playing sports or participating in gym classes because of heel pain!
Sever’s disease is the most common cause of childhood heel pain and usually affects children 8-14 years of age. Traditionally, the disease was thought to affect males much more predominately, but now that we are seeing more young women athletes, the incidence is nearing the same between genders. Sever’s disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate in the back of your heal. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus, or heel bone, has two separate areas of ossification that are connected by the cartilaginous growth plate.
Because of overuse or tight muscles, these two ossification centers are pulled away from each other causing strain on the growth plate. Overtime simple activities such as running, jumping or even standing can cause severe heel pain. I will often see children limping into my office when they have this condition.
Luckily, this is a self limiting condition meaning it will eventually go away. Unfortunately, children will have to tone down their activity schedule to reduce the pain. It is important to make the children as comfortable as possible and keep them active in their favorite’s sports, but we also have to be reasonable in the treatment options. Physical therapy will help the child stretch the muscles to decrease the pull on the developing calcaneus and Thera-band exercises can be used to strengthen the area. Ice massages will also help decrease the inflammation which is the culprit of pain. Heel lifts placed in the shoes, to decrease the pressure of the Achilles tendon on the calcaneus , and orthoses can also bring relief. Occasionally, there is need for a cast to immobilize the area to ensure proper healing. Though NSAIDS can bring relief to pain, large does are not always recommended for children. Thus, I prefer to have children to try topical pain relievers first.
Since Sever’s Disease can last up to 18 months, it is important to treat it aggressively soon as possible. Thus the child is not stuck on the bench, disappointed in their inability to perform. It may be necessary to take a short break from vigorous sports or exercise to allow proper healing time, but that is much better than sitting on the bench for an entire year!
Sever’s disease is the most common cause of childhood heel pain and usually affects children 8-14 years of age. Traditionally, the disease was thought to affect males much more predominately, but now that we are seeing more young women athletes, the incidence is nearing the same between genders. Sever’s disease is medically described as osteochondritis of the calcaneal apophysis. This is an injury to the growth plate in the back of your heal. During development, all bones in the body start as cartilage and fill in with calcium and other minerals to create a strong skeleton. This process is referred to as ossification. The calcaneus, or heel bone, has two separate areas of ossification that are connected by the cartilaginous growth plate.
Because of overuse or tight muscles, these two ossification centers are pulled away from each other causing strain on the growth plate. Overtime simple activities such as running, jumping or even standing can cause severe heel pain. I will often see children limping into my office when they have this condition.
Luckily, this is a self limiting condition meaning it will eventually go away. Unfortunately, children will have to tone down their activity schedule to reduce the pain. It is important to make the children as comfortable as possible and keep them active in their favorite’s sports, but we also have to be reasonable in the treatment options. Physical therapy will help the child stretch the muscles to decrease the pull on the developing calcaneus and Thera-band exercises can be used to strengthen the area. Ice massages will also help decrease the inflammation which is the culprit of pain. Heel lifts placed in the shoes, to decrease the pressure of the Achilles tendon on the calcaneus , and orthoses can also bring relief. Occasionally, there is need for a cast to immobilize the area to ensure proper healing. Though NSAIDS can bring relief to pain, large does are not always recommended for children. Thus, I prefer to have children to try topical pain relievers first.
Since Sever’s Disease can last up to 18 months, it is important to treat it aggressively soon as possible. Thus the child is not stuck on the bench, disappointed in their inability to perform. It may be necessary to take a short break from vigorous sports or exercise to allow proper healing time, but that is much better than sitting on the bench for an entire year!
Monday, October 5, 2009
Eli Manning Out With Heel Pain?
NY Giants quarterback, Eli Manning, was just diagnosed with plantar fasciitis. Plantar fasciitis is an inflammation of a ligament under the foot. This ligament is very strong and thick and runs from the heel bone across the arch and into the ball of the foot.
The question right now is should Eli play on Sunday and possibly risk the season. In the late 1930s, Yankee centerfielder, Joe DiMaggio, sat out three months with plantar fasciitis. Times have changed and medical treatments have greatly improved since then.
The condition can come about in several ways. Usually in the non-athlete it occurs between the ages of 35-55 and can come about from faulty foot mechanics. The foot moves in a direction called pronation and the ligament then stretches. When the foot over-pronates (the heel turning outward), the ligament will stretch excessively. Over time, this will cause the ligament to become inflammed.
For an athlete like Eli Manning, all that is needed is for him to turn his foot in the wrong direction, or to plant it and rotate the foot excessively, to bring about the condition.
Plantar fasciitis can be very painful. Imagine having pain in the heel or arch with every step you take. Then try to plant that painful foot and throw a football down field with some force. Now lets add another factor. Planting your painful foot and then moving real fast when some 300 pound linebacker is coming at you. This can lead to favoring the foot and now setting yourself up for another injury, such as a knee.
Treatment can consist of taping, steroid injections, shoe modifications, orthotic inserts, rest, ice and physical therapy. The good news is that the injury rarely needs an invasive surgical procedure. There are minor procedures such as cryotherapy or extracorporeal shock wave therapy. These treatments are meant for the chronic type of plantar fasciitis.
In my opinion, if Eli can't plant is foot fully and move quickly, he should take the week off and get ready for New Orleans.
The Doctors of Family Foot & Ankle Specialists have written three books that they offer for FREE! Got Feet?, You Do Not Have To Suffer With Heel Pain, and The Truth About Diabetes and Your Feet. Click here to have your FREE copy mailed right to your door!
The question right now is should Eli play on Sunday and possibly risk the season. In the late 1930s, Yankee centerfielder, Joe DiMaggio, sat out three months with plantar fasciitis. Times have changed and medical treatments have greatly improved since then.
The condition can come about in several ways. Usually in the non-athlete it occurs between the ages of 35-55 and can come about from faulty foot mechanics. The foot moves in a direction called pronation and the ligament then stretches. When the foot over-pronates (the heel turning outward), the ligament will stretch excessively. Over time, this will cause the ligament to become inflammed.
For an athlete like Eli Manning, all that is needed is for him to turn his foot in the wrong direction, or to plant it and rotate the foot excessively, to bring about the condition.
Plantar fasciitis can be very painful. Imagine having pain in the heel or arch with every step you take. Then try to plant that painful foot and throw a football down field with some force. Now lets add another factor. Planting your painful foot and then moving real fast when some 300 pound linebacker is coming at you. This can lead to favoring the foot and now setting yourself up for another injury, such as a knee.
Treatment can consist of taping, steroid injections, shoe modifications, orthotic inserts, rest, ice and physical therapy. The good news is that the injury rarely needs an invasive surgical procedure. There are minor procedures such as cryotherapy or extracorporeal shock wave therapy. These treatments are meant for the chronic type of plantar fasciitis.
In my opinion, if Eli can't plant is foot fully and move quickly, he should take the week off and get ready for New Orleans.
The Doctors of Family Foot & Ankle Specialists have written three books that they offer for FREE! Got Feet?, You Do Not Have To Suffer With Heel Pain, and The Truth About Diabetes and Your Feet. Click here to have your FREE copy mailed right to your door!