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Q Ive developed a bump on the back of my heel thats very painful. I tried to soak it with both hot and cold water, but that didnt help. There are days I cant put on my regular shoes because they hurt so much, and I cant work in my walking shoes. Do you have any suggestions?

A I may be able to help, if the two assumptions Im about to make are correct. Though your letter didnt provide all the details I need, I will assume that youre a young woman and your regular shoes are high heels. Then again, you might be a devotee of ice skating. That would permit me to consider a diagnosis of Haglunds Disease, more commonly known as pump bump. This is a condition where the bump on your heal represents an inflammation of the sacs (bursae) that lie on either side of the big tendon that attaches to the heel (Achilles tendon). This inflammation, bursitis or tendonitis, creates a swelling and causes the pain.

There are two contributing causes for the inflammation. One is a deformity of the heel bone (calcaneus) which causes it to stick out more than normally. This is Haglunds deformity. You cant do much about that, but the second element in this condition is your shoes. The back of your high heels presses against the bone, and squeezes the bursae and tendon each time you take a step. The more you walk or exercise, the greater the pain.

Certain shoe styles may cause you more problems than others, so the first step is to evaluate your footwear and avoid shoes that cause you the discomfort. Changing the shape and size of the counter on the offending shoes may help. You can also put a heel lift inside the shoe, to change the position of your foot, lifting the bump above the top of the shoe counter. If that doesnt help, you may have to find a new pair of shoes for work.

ACROSS MY DESK: Several weeks ago I discussed the work of Dr. James J. Jerger, professor of otorhinolaryngology at Baylor College of Medicine in Houston, Texas. His research has lead him to the conclusion that some elderly people may hear better with a hearing aid in only one ear. Though my description of his work and findings accurately describes his conclusions (I spoke with him personally to verify this), Ive received a number of letters that contest both his findings and my ability to convey technical medical information to the public.

So far, all the mail has come from purveyors of hearing aids, as well as a major manufacturer of these valuable instruments. Some letters contained reprints of publications from the literature in the field of audiology. These articles point out that Binaural Amplification (a hearing aid in each ear) has its own group of supporters, and its own set of benefits. To correct any misinterpretation of my previous column, its important that I make it clear that there is controversy about this subject, with much documentation that supports the use of two hearing aids in some patients with hearing.
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