Ask the podiatrist: Pain at the back of the heel

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Annette says: I have a weird pain in the back of my right heel, not the bottom, which feels bony and hurts more when I press it.

Hi Annette, this may one or a combination of retro-calcaneal bursitis, Haglund’s deformity, insertional Achilles tendinopathy and retro-calcaneal exostosis. From your description it sounds like a Haglund’s deformity (‘pump-bump’), which is a bony growth at the back of your heel bone, situated more to the outside (lateral) edge. The Haglund’s deformity often arises from chronic, low grade, persistent pressure and friction from the stiff heel portion (called the heel counter) of certain types of footwear, including some running shoes. Over the bony growth, with continuing pressure and friction, a condition can arise called retro-calcaneal bursitis where a protective gelatinous fluid filled sac called a bursa becomes inflamed and subsequently enlarged further presenting this area to footwear and potentially more trauma. Where there are substantial proportions of uphill and downhill work in a training programme, this can force the heel of the foot to press into the upper part of the heel counter, particularly if there is no drop in the running shoe or if the shoe’s heel cushion is worn out. Prolonged wearing of high heeled shoes can also be responsible for this trauma.

Please consult with a doctor, podiatrist and a physiotherapist who specialise in sport-related injuries for diagnosis and treatment, but try to avoid footwear that constricts the heel, older worn footwear and regimes with high proportions of uphill and downhill work. Take breaks from running and maintain overall fitness with non-impact activities such as swimming.

Michael Ratcliffe is a podiatrist and advisor for Carnation Footcare.