What is it?
Degenerative change develops in the part of the tendon that inserts into the heel bone. A spur may form within the tendon attachment, and the bursa between the tendon and bone can become inflamed. A prominent upper heel bone (a Haglund's deformity) can add pressure.
What causes it?
- Repetitive strain from running or long days on foot
- Tight calf muscles
- A prominent back of the heel bone
- Stiff shoe heel counters that press on the area
What does it feel like?
- Pain at the back of the heel, worse after rest
- A tender bump that rubs in shoes
- Pain climbing stairs or hills
- Swelling or warmth at the back of the heel
How is it diagnosed?
Exam plus X-rays to look for spurring and heel-bone shape. Ultrasound or MRI shows how much of the tendon attachment is involved.
When should you see a podiatrist?
- Back-of-heel pain lasting more than a few weeks
- A bump that is enlarging or making shoes hard to wear
- Pain that limits walking
Nonsurgical treatment
- Modified strengthening
- Calf strengthening performed without dropping the heel below level, to avoid compressing the insertion.
- Heel lifts and shoe changes
- Reduce tension and pressure at the back of the heel.
- Boot
- Short-term immobilization for flares.
- Shockwave therapy
- An option for persistent cases.
When is surgery considered?
Surgery is considered after several months of consistent conservative care, particularly when a large spur or significant tendon degeneration is present.
The damaged tendon, spur, bursa, and any prominent heel bone are removed, and the tendon is reattached to the heel with anchors. A tendon transfer may be added when much of the tendon is involved.
Related procedures
What is recovery like?
Typically several weeks non-weight-bearing or in a boot, then gradual loading and physical therapy. Full recovery commonly takes six months or more.
Frequently asked questions
How is this different from regular Achilles tendinitis?
Location. Insertional disease affects the attachment on the heel bone, often with a spur; mid-portion disease is higher up. The exercises and surgical options differ.
What is a Haglund's deformity?
A bony enlargement at the back-top of the heel bone that can irritate the tendon and bursa. It is sometimes called a 'pump bump.'