If a few weeks or months of the conservative treatment outlined in Stage 1 of the treatment guide have not been taking care of the problem, then it may be a good idea you could start to consider surgical treatment. If exuberant bone formation has already started to occur then it will probably be there for the rest of your life unless something is done about it. There is still a good chance that you will be able to greatly decrease the symptoms and pain in the region, but it will never truly be 100% cured.
If you are suffering from just bursitis and there is no excess bone formation (this can be confirmed with an Xray), then you should continue with conservative therapy or even consider the potential that something else may be causing the pain
If the pain appeared very quickly after a traumatic incident such as landing in an awkward position during basketball or after coming down from a ladder and you have a bump like this, it is also possible that you may have damaged your achilles tendon. This may be a partial or a full rupture and you would have to see your podiatrist to have this taken care of.
If the pain appears more slowly and you cannot physically feel a bump on the back of your foot then suspect that you have problems with the achilles tendon:
It is also possible that you may have a condition known as plantar fasciitis if the pain is present more in your foot and underneath your heel rather than at the back of your heel.
It is also possible to have a problem with the plantar fat pad of the heel
Make sure you went through Stage 1 of this treatment guide before attempting stage 2 and that you have properly diagnosed this disorder.
The last line of treatment before surgery should include maximum immobilization through casting or wearing a CAM boot, injecting around the bursa but not into the Achilles tendon, using an analgesic through iontophoresis.