What is the treatment for a pump bump?

Treatment for Pump Bump (Haglund's Syndrome)

The treatment for pump bump (Haglund's syndrome) should begin with conservative measures including shoe modification, orthosis, physiotherapy, and anti-inflammatory medications, with surgical excision of the calcaneal exostosis reserved for cases that fail to respond to conservative management. 1

Understanding Pump Bump (Haglund's Syndrome)

Haglund's syndrome, commonly known as "pump bump," is characterized by:

• An enlargement of the bony section of the heel where the Achilles tendon inserts
• Painful soft tissue swelling at the level of the Achilles tendon insertion
• Often bilateral occurrence, more common in females and middle-aged individuals
• Pain in the back of the heel, typically worse after rest 1

Conservative Treatment Algorithm

1. Footwear Modifications:

   • Alter heel height in shoes
   • Avoid rigid shoe backs that rub against the enlargement
   • Use open-back shoes when possible

2. Orthotic Devices:

   • Custom orthoses to correct foot mechanics
   • Heel lifts to reduce pressure on the affected area

3. Physical Therapy:

   • Eccentric strengthening exercises for the Achilles tendon
   • Stretching exercises for tight Achilles tendon

4. Anti-inflammatory Measures:

   • Nonsteroidal anti-inflammatory drugs (NSAIDs)
   • Local ice application to reduce inflammation

5. Additional Conservative Approaches:

   • Activity modification to reduce irritation
   • Iontophoresis
   • Shock wave therapy 2

Surgical Management

When conservative treatment fails (approximately 50% of cases), surgical intervention should be considered 2. The surgical approach includes:

1. Surgical Technique Options:

   • Excision of the posterior calcaneal tuberosity
   • Bursectomy
   • Debridement of diseased portion of Achilles tendon
   • Potential reattachment of Achilles tendon using bone anchors

2. Surgical Approaches:

   • Central-splitting approach (provides excellent exposure to both diseased tendon and calcaneal exostosis)
   • Medial longitudinal incision
   • Other options: lateral, Cincinnati transverse, or double incision approaches 2

3. Post-Surgical Considerations:

   • Approximately 4 weeks of post-operative immobilization
   • Patients should be informed that full recovery may take 6 months to 2 years
   • 83-90% of surgically treated cases eventually become symptom-free 3

Important Clinical Considerations

• Recovery Timeline: Patients should be informed that even with successful surgery, residual pain may persist for 6 months to 2 years before complete resolution 3

• Surgical Outcomes: Studies show good to excellent results in 97% of cases that undergo proper surgical management 4

• Diagnostic Approach: Diagnosis is primarily clinical but should be confirmed with lateral radiographs of the ankle to evaluate the calcaneal bursal projection 5

• Potential Complications:

  • Recurrence of painful prominence
  • Wound infection
  • Incisional neuroma 4

By following this structured approach to treatment, most patients with Haglund's syndrome can achieve significant pain relief and improved function, whether through conservative management or surgical intervention when necessary.