My posterior heel pain

The second area where people experience heel pain is on the back of the heel. Although there can be a connection between pain on the bottom and back of the heel, the causes of posterior heel pain generally differ from that of plantar heel pain.

The most common cause of posterior heel pain that I see is generally referred to as pump bump. Typically a woman will present to the office complaining of a sharp pain on the back of the heel just slightly off the center. There will be no history of trauma, although the patient may be required to do a lot of walking in a dress shoe. The pain will be at its worst when in dress shoes, may be less painful in sneakers and may be hardly noticeable when barefoot.

Examination of the back of the heel will reveal a slightly enlarged area that may be slightly red in color and usually very painful to touch. Not coincidentally, you will notice that the top of the patient’s dress shoe just happens to cut across the heel at that level. What has happened is that through constant wearing of dress shoes, the shoe itself has irritated the underlying bone, the bone has slightly enlarged as a result of that irritation and in an effort to protect the area of irritation, the body has formed a bursal sac which itself has become inflamed and is now a bursitis.

Below is the usual site for a ‘pump bump’ or bone spur with bursitis.

The obvious treatment would be to avoid wearing the shoes that aggravate the problem; that is easier said than done. I have been in this business long enough to know that a fashionable woman is going to continue to wear the shoes that look the best even though they might not feel the best.

That said, sometimes adding a small heel lift to the shoe will help as it may raise the heel just enough so that the top back portion of the shoe does irritate the enlarged bone and bursal sac. If the area is not too inflamed and painful, one may try some of the new gel cushions that are available in an effort to reduce friction.

From a medical stand point, short term anti-inflammatory medication may help but of course will not cure if the shoe is still irritating the area. Cortisone injections as well as physical therapy may also be effective.

In instances where conservative measures fail, the patient should entertain surgical excision whereby the overgrowth of bone is removed as well as the overlying bursitis. This is usually reserved for people who have stopped wearing the shoes that originally caused the problem, but are still having pain nonetheless. Unfortunately, many foot problems can continue to be bothersome even when the causative agent is identified and removed. (Once you have it; you have it!)