Bring Pain to Heel

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Q: I have bumps on the back of my heels that hurt when my running shoes press on them. What are they? – Sandy J.

Dr. Rehbok answers:

What you have are called Haglund’s Deformities. The technical term is retrocalcaneal exostosis.

This may sound bad but they are just bony thickenings on the back of the heel bones where the Achilles tendon attaches to the bone. There is sometimes a bursa (sack of fluid) there too.

The thickening is usually caused by shoe pressure on the heel bone, which then thickens as a protective mechanism. High-heeled shoes are a main culprit in causing this pressure.

The common symptoms are redness and swelling at the back of the heel, and blisters may also develop from the pressure or friction.

Treatment depends on the severity and cause. In mild cases, this inflammation and projection of bone at the back of the heel can be relieved with ice, compression, change of shoes (a shoe with a softer heel counter) or an Achilles heel pad or lift. A simple, soft spongy material can be glued into the heel counter to cushion the area. I sometimes actually remove the heel counter stiffening material to reduce the pressure on the heel.

If the bone is enlarged, surgery may be needed but this would be the absolute last resort. This procedure is complex and the recurrence rate is relatively high because of the complex nature of the Achilles tendon attachment. Cortisone injections can also help relieve the pain. However, a long-term complication of cortisone injections is an increased chance of rupturing the Achilles tendon.

Other treatments include immobilisation and anti-inflammatory medications.

Dennis Rehbok is a qualified podiatrist practising in Johannesburg. Visit his website

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