"Doc, please do something about my feet" pleaded the young patient sitting in my treatment chair "they hurt every time I march." Her name is Jennifer and she is a freshman at a local high school. She is also in the marching band. After the band made a parade appearance she could no longer take her foot pain. She pointed to a bright red bump on the back of each heel. In the past these have been called, among other names, pump bumps. I see them so often in band members, maybe I should refer to them as band-bumps.

The heel bone, called the calcaneus, is shaped like a rectangle. Normally it fits neatly into the heel counter of shoes because the back of the shoes is also, more or less, rectangular. Through an interesting quirk of biomechanics, people with high arched feet have a heel bone that leans a bit to the outside. That means that the upper-outer side of the heel bone pushes against the heel counter of the shoe. The shoes most kids wear are soft. If a child has a high arch foot the rubbing is kept to a minimum by their soft shoes. With adolescence comes more demanding shoe styles (or band boots) and symptoms can follow. Elevation of the heel causes the heel bone to lean even further to the outside. A non-painful heel can develop symptoms for the first time with high heels. This is how this malady got its quaint name of pump bump.

Jennifer’s symptoms were classical. She has a hard swelling on the back of her heel right next to the spot where the Achilles’ tendon inserts. Because of shoe irritation it was bright red and very tender to the touch. An x-ray confirmed that there was no tumor, fracture or other cause of her pain. It did show that the edge of the bone had overgrown (an exostosis for the medically inclined). This overgrowth of bone, along with the swelling from inflammation, has caused the lump that does not fit well into her boots. Now that it was symptomatic, it even hurts in athletic shoes.

Most people respond to conservative care. I told Jennifer to avoid any shoes that put pressure on the bump. Fortunately, the band season is mostly over for this year. If she had to march, she could either stretch the shoes over the bump, appropriately pad the shoes (or her feet) to take the pressure off the bump, cut a hole in the shoe over the bump or ask permission to wear another type of shoe.

Ice massage is great therapy. I asked Jennifer to rub the area for 20 minutes three times a day with ice with a circular motion. Cold therapy slows or reduces the amount of inflammation. Finally I asked her to try a short course of an oral anti-inflammation medication.

Once people are aware of the cause of their pump bumps they can sometimes modify their shoe styles to accommodate their feet. Guys who wear lower and wider shoe styles find this easier to do. For women and girls this can be almost impossible. Jennifer wants to be, heaven forbid, a lawyer and will probably need to wear pumps on a daily basis. If her feet still hurt after her conservative therapy and if she foresees that she cannot make it through another band season (let alone her legal career), I told her that there is a surgical solution. Through a small incision the bump on the back of the heel can be shaved right off the bone. The surgery is very successful, has very few complications and will get her back to pain free walking in any of her shoes – even band boots.