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Topics discussed on this page:

Posterior Heel Spur
Retrocalcaneal Exostoses
Haglund's Deformity
Pump Bump
Calcific Tendinosis
Insertional Calcific Tendinosis
Equinus
Achilles Tendonitis
Bursitis

One common condition seen by podiatrists is an abnormal bony growth on the back of the heel. These are known as Posterior Heel Spurs or Retrocalcaneal Exostoses.

There are two basic varieties of posterior heel spurs, each with a different cause:

Chronic excessive pull of the Achilles tendon on the back of the heel. Strongly correlated with Achilles Tendonitis, this entity is more properly known as calcific tendinosis, or insertional calcific tendinosis, terms that means that the Achilles tendon is degenerating from chronic excessive pull, and is calcifying. This condition is more common with a condition known as Equinus, or a tight muscle group on the back of the heel.

The radiograph to the right demonstrates an example of calcific tendinosis. As you can see, the bony bump is not really attached to the heel bone, but seems to float in mid air. This demonstrates calcification within the Achilles Tendon itself.

Direct rubbing of the heel against a shoe. This entity is known most commonly as a Haglund's Deformity or a 'pump bump'.

The radiograph to the right demonstrates an example of a true Haglund's deformity. In this case, the bony bump marked with the black line has developed on the heel bone itself, from chronic irritation cause from rubbing of the heel bone by a shoe.

This next radiograph to the right demonstrates the same heel bone after the uncomfortable bump has been surgically removed.

Both types of posterior heel spurs--calcific tendinosis and a true Haglund's deformity--are often associated with an inflamed bursa known as an Achilles Bursitis. A bursa is a fluid-filled sack that serves to protect and cushion a structure, and in the case with the Achilles tendon, a bursa likes in front and behind the tendon. Either bursa may get irritated and inflamed by friction against the shoe and tendon.

Several treatments exist to control the symptoms associated with these conditions.

Rest, ice, compression, elevation, anti-inflammatory medications and physiotherapy (e.g., ultrasound and laser) will often help for short-term acute flare-ups of either variety of posterior heel spur.

Accommodative padding and over-the-counter and custom-made accommodative orthopaedic appliances are particularly helpful for a true Haglund's deformity, as is a change in shoe gear to one with no pressure on the bump.

Taping is particularly good for the tendon component of posterior heel pain. Short-term use of high-heeled shoes can offer some improvement, too, by putting some slack in the Achilles Tendon--but long term use of high-heel shoes worsens the condition. Stretching the major muscles that make up the Achilles Tendon (the Gastrocnemius and Soleus muscles) works wonders over the long run.

Steroid injections, still frequently used for both these conditions, should be used very judiciously because of their tendency to weaken tendons.

One exciting new treatment that can be used for posterior heel spur pain, tendinitis, and calcific tendinitis is Extracorporeal Shockwave Therapy, or ESWT. This technology is analogous to lithotripsy, the technique that uses shockwaves to break up kidney stones instead of surgery. We are pleased to be able offer the newest form of this technology available anywhere, piezoelectric shockwave therapy. We have enjoyed a success rate of 85% for patients with this condition. For more information on this technology, visit the website of our partners, Shockwave Therapy - BC.

When conservative measures fail, both varieties of posterior heel spurs can be treated surgically. The simplest procedure involves simply removing the spur, but there are multiple types of procedures that may be considered, especially if the tendon needs to be addressed or if the bone needs to be realigned in some manner.

For more information on general heel pain, please visit our Web Page on that topic.