Achilles Tendinitis, Bursitis, and Haglund’s Exostosis

The Cause

Pain in the back of the heel is usually caused by one or a combination of three conditions.  Achilles tendinitis is an inflammation of the heel cord.  Retrocalcaneal bursitis is an inflammation of the bursa, or fluid filled sac, located between the Achilles tendon and the calcaneus (heel bone).  Adventitial bursitis is a painful enlargement of the bursa between the skin and the Achilles tendon.  This is often aggravated by a tight shoe heel counter irritating the back of the heel, and is sometimes referred to as a “pump bump”.

Haglund’s Deformity

In some patients, retrocalcaneal bursitis is associated with a bony prominence on the calcaneus.  This may be seen on an x-ray.  This bony spur may press on the bursa and the Achilles tendon, further irritating the condition.  The bony prominence has been called Haglund’s deformity or Haglund’s exostosis.

Treatment

Non-surgical treatments are always tried first.  A simple pump bump may be relieved by softening the shoe heel counter and using a pad to decrease the pressure against the inflamed area.  The other types of posterior heel pain are treated with anti-inflammatory medications and a heel lift in the shoe to decrease tension on the heel cord and relieve the impingement on the inflamed area.  Treatments such as physical therapy, PRP injections, and ultrasound can be effective in some patients. 

Surgery

If heel pain persists despite non-surgical treatment, surgery is an option.  This may include removing the inflamed bursa or cleaning out the inflamed portions of the tendon.  Removal of some of the calcaneus may be necessary if it is rubbing against the tendon.