A retrocalcaneal exostosis is a painful bump or bone spur on the back of the heel bone (calcaneus). This painful bone spur often involves the achilles tendon. A Haglund’s deformity is a painful bone spur on the back of the heel that does not involve the achilles tendon.
Patients will often complain of pain, redness, tenderness and swelling along a bony prominence on the posterior aspect of the heel. Usually the pain is worse with activity and with shoes that rub the back of the heel.
The patient typically has pain at the insertion site of the achilles tendon on the back of the heel bone. Sometimes the achilles tendon will feel thick, hardened, or rubbery where it inserts on the posterior aspect of the heel. This may be due to the tendon becoming calcified or a possible tear of the tendon.
This particular problem most often affects adults. Women are typically more affected than men because of the types of shoes they wear. High heeled shoes or pumps irritate the spurs the most.
A retrocalcaneal exostosis can occur with other problems along the back of the heel. These issue can include: tight or short achilles tendon, bursitis or an inflamed pad, achilles tendonitis or inflammation and a Haglund’s deformity.
If a patient has equinus or a tight or short achilles tendon, this lack of flexibility of the achilles tendon puts increased tension on the back of the heel.
A bursa is an inflamed sac of fluid that develops as a way of your own body cushioning the back of the heel. There are 2 types of bursae that can form. One is superficial and lies in between the skin and the achilles tendon. The other type of bursa is sandwiched between the achilles tendon and the heel bone or calcaneus. When they become inflamed, it can become tender with even the lightest pressure.
If the achilles tendon itself is inflamed and swollen, it may be due to a tear or partial rupture of the achilles tendon.
Treatment of Retrocalcaneal Exostosis depends on the severity of your pain level. Treatment includes:
1. A prescription for an oral NSAID or steroid. This will help with inflammation of the tendon, bursa, skin other structures in the area.
2. Prescription for a pain gel or adhesive pain patch to apply to the back of the heel. These medications are diffused through the skin into the tissues.
3. Heel lifts are usually dispensed to the patient. Heel lifts are a wedge that goes under the heel to lift the heel. By raising up the heel an inch or so, the tension on the achilles tendon is decreased. The heel lift can also raise the patient’s heel out of the shoe slightly to keep the back of the shoe from rubbing on the heel.
4. Cushioning or padding of the back of the shoe or the heel counter. Adhesive felt pads can be used to stick on the inside of the heel of the shoe to provide some cushioning.
5. If the pain is severe, immobilization in a boot is warranted. By decreasing stress and strain of the achilles tendon, the pain and inflammation at the back of the heel will decrease significantly.
6. The last conservative option for severe pain is cast immobilization. Crutches would be warranted for non-weightbearing of the extremity.
7. Steroid injections are not customarily performed along the back of the heel due to increased risk of possible rupture of the achilles tendon, especially if the tendon is already inflamed and diseased.
8. Sometimes physical therapy is warranted to help increase flexibility of the achilles tendon and to decrease inflammation of the tendon using techniques customized by the physical therapists.
9. MRI is typically performed if the tendon continues to be painful. The MRI can help determine if the achilles tendon is inflamed or torn. The MRI can also help identify an inflamed bursa, or some other soft tissue pathology.
10. If the previously mentioned conservative methods are unsuccessful at relieving the pain, then surgery may be warranted. Surgery along the back of the heel can involve the following: Debulking of the achilles tendon or trimming away of the disease portions of the tendon, removal of the bone spurs on the back of the heel, removal of the bursa, lengthening of the achilles tendon and reattachment of the tendon to the heel using bone anchors and strong sutures. Dr. Silvers has been performing these procedures for many years with favorable results.
All conservative treatments must be exhausted prior to surgery.
If you have a spur on the back of your heel and it is causing you pain, please come see Dr. Eric Silvers at Advanced Foot & Ankle Center for diagnosis and treatment.
Please call 972-542-2155 for an appointment today.