Still think high heels are worth it

It's not what fashion-conscious women want to hear-another warning about high heels. But, according to the American College of Foot and Ankle Surgeons, pump-style shoes often cause significant pain by irritating a common bony deformity on the back of the heel, called "pump bump." In many cases, it can lead to bursitis or Achilles tendonitis, if left untreated.

"Pump bump is common in young women who wear high heels almost every day," said Marybeth Crane, DPM, FACFAS, a Dallas-area foot and ankle surgeon whose practice near DFW International Airport is well populated with flight attendants. She said the employee dress code on most airlines requires flight attendants to work in high heels, and their feet take a beating as a result.

"The rigid back of a pump-style shoe can create pressure that aggravates the heel bone when walking," said Crane.

According to the ACFAS consumer Web site, FootPhysicians. com, the bony enlargement can cause Achilles tendonitis or bursitis due to constant irritation in pump-style shoes. Those with high arches or tight Achilles tendons are especially vulnerable to developing pump bump, if they work in high heels.

The medical term for the disorder is Haglund's deformity. In addition to the noticeable bump, symptoms include pain where the Achilles tendon attaches to the heel, swelling in the back of the heel and redness in the area.

In the large majority of cases, pump bump is treated nonsurgically by reducing inflammation, but this does not get rid of the bony enlargement. "Pain relief is the primary treatment goal, so anti-inflammatory medications usually are prescribed," said Crane. She added that icing the back of the heel reduces swelling, and stretching exercises can relieve tension in the Achilles. Long term, however, it's best to avoid wearing high heels, if possible.

"When the office or airline dress code requires high heels, I advise women to try heel lifts to decrease pressure on the heel or wear appropriate dress shoes that have soft backs or are backless," said Crane.