Painful Heel Lump or Bump on the Back of the Foot [Best Treatment!]
Painful Heel Lump: Back of the heel pain is usually Achilles tendinitis, a bone spur or Achilles bursitis. Make 100% sure your Achilles heel pain stops!
Back of the heel pain is most commonly caused by Achilles tendon and back of the calcaneus damage.
The most common causes of back heel pain are:
- Fat pad atrophy that can lead to calcaneus bone pain.
- Insertional Achilles tendinitis pain.
- Achilles tendinitis 2-6 cm above the heel bone.
- An Achilles tendon strain or rupture.
- Nerve impingement or entrapment in the heel.
- Achilles tendinosis.
- Back of the heel spur pain.
- Achilles tendon bursitis.
Overview of Back of the Heel Pain:
Insertional Achilles tendinitis:
- If you have found your way to this page, this is likely the type of pain that you are thinking about.
- This can be classified by a few different names. There are numerous overlapping problems that can contribute to insertional Achilles tendinitis.
- These are known as a Haglund’s bump, heel spur bursitis, Achilles fat pad inflammation, insertional Achilles tendon spur, and it does go by many other different names.
- Spurs can also be called an enthesophyte.
- This is most common, but not in the back of the heel.
This is called plantar fasciitis:
- This involves bone spur formation at the bottom of the heel or the sole of your foot.
- This is very frequently associated with the tightness of your plantar fascia, and this does that heel spur to form.
- But this is on the bottom of your foot. Not where your Achilles tendon inserts.
- The most common causes of a heel lump or bump are the swellings associated with insertional Achilles tendonitis.
- This can then lead to bursitis or a back of the heel spur.
What is Insertional Achilles Tendinitis?
- Insertional Achilles tendinitis inserts into the back of the heel bone.
- This is where the Achilles tendon connects your big thick calf muscle into the back of the heel bone.
- A bone spur can gradually develop around the tendon where inserts into the bone.
- This is a chronic development.
This is a large painful bump and lump at the back of the heel. This is called an insertional Achilles tendon heel spur.
How Does a Heel Spur Form?
- Think about the heel spur and thickening as a gradual ripping out of the bone heel bone.
- Your calcaneus bone is trying to heal but it almost gets stretched out along with the tendon as a few years go by, this eventually looks like a spur has formed.
How Long Does A Spur Take To Form?
- This spur formation process usually takes many months or many years to develop.
- When we go to the site surgically, it looks more like a hard sand rather than thick spiky bone.
- So don’t get too scared just yet! It does not always mean that you need some type of surgery.
Does A Spur Mean Permanent Damage?
- Yes it is true that a bone spur is associated with Achilles tendon damage, the bigger the spur means usually more tendon damage and pain.
How Does This Differ From Bursitis:
- The inflamed and damaged insertion of the Achilles tendon can be calcified hard bone.
- But this can also cause the Achilles fat pad to become inflamed. This can also be called back of the heel bursitis.
Who is at risk for insertional Achilles tendinitis?
- Insertional Achilles tendinitis is usually associated with tightness through your hamstring muscles in your calf muscle.
- Yes it is true that the older you get, the stiffer your tendons in your joints generally tend to get.
- People who are usually in their 40s, 50s and 60s tend to have more stiffness especially with a high workload.
- I see this most commonly with people who spend the majority of the day standing.
- Achilles tendinitis usually develops gradually over years or decades and it is not linked with a single injury.
- Running and jumping can significantly make the back of your heel pain worse.
- People usually feel it while walking up and down the stairs or standing on hard concrete a good portion of the day.
- The more activity you do the more pain and inflammation you will have.
Why Achilles Heel Spur Insertion Pain is So Hard to Treat:
Why heel spur insertional pain is hard to treat?
- Everybody treats this differently and doesn’t really take it all that seriously as a non-surgical treatment method.
- They see a very large thick spur or bone build up and assume that they must remove it surgically.
- Some people treat this disorder by stretching, some people are treated by ultrasound and massaging, and some people do it by physical therapy techniques alone.
- It is possible to fix it without surgery!
Let The Inflammation Cool Down.
- The bottom line though is most people never let inflammation cool down.
- People continued to stay stiff and painful while doing every other possible treatment method.
- They continue going to work every day, and they continue trying to power through it and walk or run.
- No pain no gain does not work here! Pain just causes it to stick around forever.
So What Can You Do?
- Find a way to relax the back of your heel so you’re not walking all day.
Get Off Your Feet!
- This can be tough if you weigh 300 or 400 pounds, or stand on concrete for 12 hours a day.
- This is where icing and anti-inflammatory creams can be good.
- I’m not a huge fan of taking pills to solve this problem, it is not a permanent solution.
- Find ways to sit down, find ways to get someone to help you at work.
- But if you’re a runner or something that can be controlled, take a break from running.
- If you are walking for exercise, switch to weight lifting or something else.
- Switch to biking, swimming and upper body weight lifting for a few weeks or months.
Find ways to take pressure off of the Achilles Tendon:
- The best way to do this is to find great shoes.
- Great shoes are then best combined with great orthotics.
- Sometimes a lace up ankle brace may be needed if the first two options don’t work. Usually with these three things you can take an amazing amount of pressure off it.
- The key is to actually wear them. Wearing these devices during dinner and walking barefoot for the other 23hrs of the day won’t fix the problem.
- For some people if the pain is bad, they may need a cast or boot for at least a few weeks.
- Go see your podiatrist and get an x-ray of your heel if you think something might be broken, even a pair of your Achilles tendon may need it an ultrasound or an MRI.
Best Supportive Shoes:
- The key to prevent your heel pain is to have a good supportive shoe that supports your ankle joint and subtalar joint from everting.
- If you have a good supportive shoe, that keeps pressure your joints so that your ankle, Achilles tendon and subtalar joint does not have to work as hard.
- This almost seems counter-intuitive, but when people make a switch to really good supportive shoes that fit properly, the ankle and Achilles tendon pain should gradually start to improve.
Stabilize the Heel With Orthotics:
- Whether the tendon is too tight or not is not the problem it’s how compressed the Achilles tendon gets against the back of the heel.
- You have to find a way to keep the heel bone from tilting up so much and pressing the Achilles tendon against the back of the heel bump.
- When it’s loaded, the calcaneus gets turned up and out.
- This twisting is when the bone rubs against the Achilles tendon the most.
Full Length Orthotics Stabilize Your Heel the Best:
- These are our favorite full length orthotics.
- These will support your heel much better than a 3/4″ length orthotic.
- The main downside is the tighter fit, so get your shoe 1/2 a size bigger.
These are the best non-lace shoe orthotics:
- These work best if your shoe is really tight and you still need a good fit!
These are the best dress shoe orthotics:
- These are our recommended orthotics for dress shoes.
Heavy duty ankle stability braces:
- If your pain is severe, these are our favorite heavy duty braces to stabilize your ankle and heel.
Compression ankle braces:
- These are best for when your pain has cooled down a little bit.
- These are also great when you are in a tighter shoe that the heavy duty brace would not fit into.
Fix the underlying problems:
These are: Too much pressure and too little flexibility.
- If this truly is a life altering condition that you have a hard time fixing, make some of the tough choices.
- For example, I can guarantee you if you were a computer programmer and weighed 100 pounds, there is almost no chance that you would have Achilles tendinitis.
- But if you weigh 300 pounds and work on a factory floor 16 hours a day, there’s about a 95% chance that you will have knee arthritis, Achilles tendinitis, hip and back pain. One of these is guaranteed.
Why does Achilles tendinitis persist long term?
2 short answers: Too much pressure and too little flexibility.
- I’m not saying you must meet all these tough criteria listed above.
- Even losing 5 to 10 pounds can take a significant amount of pressure off your feet.
- Even stretching 1 minute every morning can make a huge difference!
- Because the important thing is once you heal this problem, you don’t want it to ever come back.
- There is no doubt about it Achilles tendonitis takes forever to get better, so give it a chance for a few weeks or months to cool down as in step 1.
- Then correct the reasons that cause that to happen in the first place, and it will stay away forever.
Stretching Does Help (Even if it doesn’t fix it alone):
- Even if it doesn’t fix the problem completely alone, this is a great modality to reduce Achilles tendinitis.
- Once you understand this concept you will understand why it happens, think about it is a rope going along the tree and you pulling against that rope.
- We have to find a way to get that bone to stop rubbing against the Achilles tendon. A lot of the times it’s by lifting up the heel bone, or getting rid of that top of the bone spur.
- An orthotic and shoe is a good way to do this long term, not stretching. But this only works if the tendon cools down from swelling first.
Our favorite static stretching devices:
- These devices mean that they do the stretching for you.
- You could wear these while watching TV for 15-30 minutes at a time.
- Studies show you will gain significant ankle flexibility after 1 month of daily wearing.
Other Causes Of A Painful Back Of The Heel Lump:
1) Back Of The Heel Bone Formation:
- A lump or bump at the back of the heel is a Haglund’s bump.
- It can also be called an enthesopathy: this means calcification of the Achilles tendon.
- This is basically excess bone that forms over time due to improper rubbing and biomechanics.
- This is especially likely in females that wear improper shoes like flats or high heels.
- This excess bone formation of bone at the back of the heel can put pressure on the soft tissue.
- This will eventually lead to irritation and inflammation in the area.
2)Back Of The Heel Bursitis:
- There are two gel-like pouches on the inside and on the outside of your Achilles tendon.
- These pouches are known as bursa.
The normal function of the bursa is to provide a lubricated surface for the Achilles tendon to slide.
- It should allows the tendon to slide between the bone and the skin.
- If one of these get inflamed or damaged you can get a condition known as bursitis.
Who Gets A Back Of The Heel Lump Or Bump:
- The most likely demographic to be affected are females aged 20-30 years old. This is when a Haglund’s bump is most noticed.
- Especially those who wear high heel shoes.
- It is more likely in people with a high arched foot.
- Those who frequently have friction against the back of their heel.
- But It can happen to anyone.
Back Of The Heel Lump Or Bump Symptoms:
- Can be fast on setting pain or very gradually on setting pain.
- Pain that hurts before motion and starts to get better as you move around more.
- The back outside of your heel is painful.
- Achilles tendon insertion pain is likely.
- Inflammation and redness likely in the skin.
Painful Heel Lump X-rays:
- Large bump on the upper outside of your heel (Haglund’s deformity).
- Calcification of the insertion of the Achilles tendon.
- Soft tissue swelling (bursitis).
- Rule out any damage to the Achilles tendon.
- Rule out any heel spur.
Other Back Of The Foot Pain Causes:
- If the pain appears more slowly and you cannot physically feel a bump on the back of your foot.
- Suspect Achilles Tendinitis.
- Suspect this if the bottom of your heel is hurting.
- Suspect this if your arch is also hurting.
- This is the most common cause of heel pain.
- Suspect these if you have numbness burning or tingling.
And don’t forget… GREAT Shoes!
Back of the heel pain treatment:
Best Back of Heel Pain Treatment:
- There are usually two phases to treating back of the heel pain.
- The two phases of treatment include controlling the acute inflammation, and correcting the biomechanics which led to the problem in the first place.
- If the tendons and ligaments are inflamed, they are almost frozen in place and cannot function properly.
- Once the inflammation is decreased, we need to correct the bio-mechanical causes to ensure that the Achilles tendon can never become over worked and inflamed again!
- This doesn’t matter whether it’s The back of the heel spur, fat pad atrophy, insertional Achilles tendinitis, Achilles tendinitis or even Achilles tendinosis.
- If you do have an Achilles tendon rupture or tear, seeing a podiatrist care immediately.
Achilles Tendon Natural Treatment:
Massage & Ice Products:
- Ice is the an excellent option that can be safe for almost everyone.
- There is some debate whether icing is worth doing, but for chronic pain this can help limit the need for medications and keep your options open.
- This works great for your arch, less for the ball of the foot.
- Manual massage on the Achilles tendon & calf muscle is a natural treatment that can also be considered physical therapy for your back of the heel pain.
- This works well for calf muscle pain and Achilles tendon pain.
- The more muscle and ligament tissue there is, the better ice will work there.
Menthol Based Gels:
- Biofreeze is one of our favorites.
- These gels have been studied to work 2x as long as ice.
- This works great for the ball of the foot.
- This can be very effective for pain relief, but this can decrease inflammation in the calf muscle and Achilles tendon.
- These can work great for loosening your muscles.
- This allows less tightness and pressure onto the plantar fascia and heel.
- This is very effective for the arch, the gastrocnemius or calf muscle and for the hamstring and thigh muscles.
- This also works very well for the gluteus muscles if you are having butt cheek or hip pain.
- The massage stick can break up lumps in your Achilles tendon and heel pain.
Remove the Achilles tendon tightness.
- The key is to prevent future pain stress and trauma to the Achilles tendon muscle.
- This means keeping you active while keeping stress off of your Achilles tendon. This will prevent future re-injury and development of plantar fasciitis.
- If you can get rid of the pain and swelling, this will let you start walking normally.
- If you can walk normally, the vast majority of your pain should gradually start to go away.
- The best way to ensure that your plantar fascia, foot and ankle ligaments are not overworked is to support them.
- The best way to support them is to use great orthotics and great shoes.
- Some people may also need to rely on supportive ankle braces and other supportive modalities.
Best Shoes for Back of Heel Pain:
- Getting a great supportive pair of Achilles tendonitis shoes will make sure that there is pressure removed from the heel and plantar fascia region.
- This is especially important if you have plantar fasciitis, heel spur pain or Achilles tendonitis as well.
- Consider Achilles tendonitis shoes combined with a good supportive orthotic for best pain relief!
- The following link will show you what our favorites are.
Best Achilles Tendonitis Insoles:
- These are our recommended orthotics for Achilles tendonitis.
- Custom orthotics can work very well, but they should not be a first line of treatment due to the cost.
- There are different types for different shoes.
- Women’s shoes usually need a less bulky orthotic, but allow for less correction.
- A full length orthotic requires a running shoe, boot or comfortable walking/dress shoe.
- We recommend doing everything you can to get a good supportive shoe that can fit a full length orthotic.
- A further home remedy tip for Achilles tendonitis pain is to cut out a hole where the nodule is using scissors or a knife. Be careful and start with a very low cost orthotic.
Best Full Length Achilles tendonitis Orthotics:
- These will only work in wider shoes or a good supportive running shoe.
- This will not work in sandals, flats or most women’s dress shoes.
Best Dress Shoe Achilles tendonitisOrthotics:
- These are a great choice for dress orthotics.
Best 3/4 Length Achilles tendonitis Orthotics:
- These are great options for women’s dress shoes and thinner shoes.
- These are not the most supportive pair of orthotics.
Get A Great Dynamic Stretch:
- It is possible to stretch on your own, but these products can also really help!
- This will take pressure off of the ball of your foot.
- This is a for of back of the heel pain physical therapy that breaks up the scar tissue.
- We personally prefer this method of stretching.
Get A Great Static Stretch:
- These devices are great for stretching while you are resting.
- This is a very good Achilles tendonitis physical therapy that you can do at home.
- This will also help take pressure off of the ball of your foot.
- This works great for plantar fasciitis.
- It can be used while watching TV or at night time.
Best Heel Compression Brace:
- A good compression brace can stabilize your foot from turning outward.
- This prevents your foot from pronated.
- Pronated foot will turn your foot outward in your foot will rub on the outside of the shoe.
- For many of her patients this has solved their pain and is very comfortable to wear inside your shoe.
- This solves both pain and outward pronation for a relatively low cost.
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Best Heel Stability Brace:
- Stability brace goes little bit further than the compression brace to stop your foot from turning out.
- This takes pressure off of your heel and plantar fascia.
- At the same time this is a little bit bulkier and does not affect every shoe.
- We find people are little bit happier trying the compression brace before the stability brace.
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Severe Achilles tendonitis Pain:
- If you think you might have a broken heel, a calcaneal stress fracture or something of similar severity, these products might help!
- Always remember to see a foot and ankle specialist like a podiatrist if you are having plantar fasciitis or more severe pain!
Plantar Fascia Tear, Broken Heel Bone, Achilles Tendon Tear:
- If you have a traumatic injury such as a torn plantar fascia ligament, calcaneus stress fracture, heel fracture or insertional Achilles tendon injury: consider protecting your foot!
- The best way to do this is of course to see your podiatrist and get evaluated with an x-ray, ultrasound and potentially even an MRI or CT scan.
- If you are unable to do so it may benefit you to be in a cast, fractured boot, or even keep the weight off of it with a rolling knee scooter or other protective devices.
- We as podiatrists frequently take patients off work for very long period of time when they suffer a traumatic injury, unfortunately there is no other way around us in labor jobs.
- If you have a sit down job there are ways to get people back to work quicker, but this can be very difficult otherwise.
Heel Injury Boot Treatment:
- There are pros and cons to using a boot to treat your heel injury. If you are immobilized too long the cons are that you will gradually become stiff and overworked to your other leg. The Pros are that you injured heel will hopefully have a chance to gradually heal!
- Our favorite fracture boots and their supplies:
Offloading and Scooter treatment:
- These are favorite knee scooters and walking devices.
- If your Achilles tendonitis pain is severe, offloading it can be very effective until the pain calms down.