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 produced by a tight shoe heel counter irritating the back of the heel, and is 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 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 superior heel pain are treated with oral anti-inflammatory medicines and a heel lift in the shoe to decrease tension on the heel cord and relieve the impingement on the inflamed bursa.

Surgery

Occasionally, the heel pain persists despite conservative treatments.  In these patients surgical intervention may be necessary.  This may include removing the inflamed bursa or cleaning out the inflamed portions of the tendon.  Sometimes it is necessary to shave down the offending bony prominence on the calcaneus.