This problem is more commonly seen in females, due to wearing tight, inflexible shoes.
The basic reason is a constant pressure or stress on the bone. Shoes with stiff backs such as dress shoes, pumps, skates, etc., press at the back of the heel and are a major cause for the development of these painful bumps.
A tight Achilles tendon leads to repeated excessive pulling at its point of attachment, leading to the formation of heel spurs.
A high arch leads to backward tilting of the heel bone, making the bump of the heel more prominent and susceptible to pressure from shoes.
A tendency to walk on the outside of the heel is also considered a significant contributory factor.
A foot that over-pronates will change the line of pull of the Achilles tendon and strain its attachment.
Formation of a visible bump at the back of the heel, which is tender to the touch
The bump rubs against the back of the shoe while walking or running, causing pain
The overlying soft tissues and skin may also become inflamed, leading to swelling and pain in the area.
The repeated friction from tight shoes may also lead to thickening of the overlying skin (callus formation).
The symptoms and clinical examination aid in determining the cause of the problem. X-rays help to analyze the structure of the heel bone and differentiate the condition from other causes of pain in the retrocalcaneal area.
Conservative treatment is aimed at resolving the painful symptoms; however, it has no effect on the retrocalcaneal exostosis itself.
Avoid shoes with stiff backs or straps that press on the area
Heel lifts help to elevate the heel out of the shoe, preventing contact of the tender area with the back of the shoe
Use padding to reduce friction
Use NSAIDs and apply ice packs, to counter pain and inflammation
In case of high arches, use of insole devices such as arch supports helps to reduce stress on the heel.
Stretching exercises help relax a tight Achilles tendon and reduce pressure at the back of the heel.
Innersoles to correct any foot abnormalities (over-pronation)
Surgical treatment is advised in chronic cases. It may involve removing the bump alone (exostectomy) or removing the bump along with a part of calcaneus (calcaneal osteotomy). The latter procedure is found to give better results. The Achilles tendon may need to be detached and reattached during the procedure
The foot is immobilized for about six weeks after surgery. As the Achilles tendon has a poor blood supply, the area needs more time to heal properly. Post-operative care is imperative to prevent complications.