Heel pain at the back of the foot is a common problem I see in Dhaka, especially in people who wear stiff shoes, stand for long hours, or walk long distances for work and family responsibilities. Many patients point to a painful bump at the back of the heel and say, “Doctor, this shoe rubs here and the pain is not going away.”
Two related conditions often explain this pattern: retrocalcaneal bursitis and Haglund deformity. They are not exactly the same, but they often occur together. A clear explanation helps patients choose the right treatment instead of trying random creams, repeated pain medicine, or aggressive massage.
What is retrocalcaneal bursitis?
A bursa is a small fluid-filled sac that reduces friction between tissues. Behind the heel bone (calcaneus), there is a bursa that sits between the Achilles tendon and the heel bone. When this bursa becomes inflamed, it is called retrocalcaneal bursitis.
In practical terms, patients feel:
- pain at the back of the heel, especially when walking uphill or climbing stairs
- swelling or tenderness around the Achilles insertion area
- pain when shoes press on the back of the heel
What is Haglund deformity?
Haglund deformity refers to a bony prominence at the back-upper part of the heel bone. Some people call it a “pump bump” because stiff shoe backs irritate that area. When the bone prominence repeatedly rubs against the shoe and the Achilles tendon region, inflammation can develop.
One important point I want Bangladeshi patients to understand is this: Haglund deformity is not only a skin problem. It is often a combination of bone shape, shoe friction, and Achilles tendon irritation.
How these conditions are connected to the Achilles tendon
Many patients have more than one issue:
- the bony heel prominence creates mechanical rubbing
- the bursa becomes inflamed (retrocalcaneal bursitis)
- the Achilles tendon insertion becomes irritated (insertional Achilles tendinopathy)
If we treat only one part, pain may return. That is why diagnosis matters.
Common symptoms I see in Dhaka
Patients usually report a few typical features:
- pain at the back of the heel when wearing shoes with a hard heel counter
- redness or swelling after walking
- a visible bump that becomes tender
- morning stiffness near the Achilles insertion
- pain when going upstairs, walking fast, or standing long hours
Some patients notice the pain improves when they wear sandals, but returns immediately with closed shoes. This pattern is a strong clue.
Why it happens: risk factors and triggers
Haglund deformity and retrocalcaneal bursitis can occur for several reasons:
Foot shape and tight Achilles tendon
High arches, a tight calf muscle, or a tight Achilles tendon can increase pressure at the back of the heel. When the heel cord is tight, it pulls more on the insertion area and increases friction.
Shoe design and daily habits
Stiff shoes with hard backs are a common trigger. In Bangladesh, some people wear tight school shoes, formal shoes, safety footwear, or closed shoes during long workdays. Repeated rubbing can inflame the bursa and irritate the tendon.
Sudden increase in walking or running
When activity increases quickly, the Achilles region may not adapt in time. This is common in people who start walking for weight loss, begin running, or increase travel on foot.
Being overweight
Extra body weight increases load on the Achilles and heel region. It does not mean the patient is at fault. It simply means we should include weight management and strengthening in the plan.
How I evaluate this problem
When I evaluate patients with back-of-heel pain, I focus on:
