Finding a bump on your heel can be a surprising and sometimes painful discovery, prompting immediate concern about its cause. These swellings most commonly appear on the back of the heel bone, known as the calcaneus, often near where the Achilles tendon connects. The bump’s nature varies widely, presenting as a firm, fixed bony prominence or a softer, fluid-filled mass. Understanding the specific location and characteristics is the first step in identifying whether the issue is structural, inflammatory, or purely a skin concern. This article explores the most frequent underlying causes of heel bumps and provides guidance on how to differentiate them.
Bony and Structural Causes
A hard, fixed bump on the back of the heel is frequently Haglund’s Deformity, an enlargement of the calcaneus bone. This prominence on the posterosuperior corner is often called a “pump bump” due to its association with rigid footwear. The bony enlargement rubs against soft tissues, such as the bursa and Achilles tendon, causing localized irritation and pain.
Foot structure plays a large role in this development; individuals with high arches or a tendency to walk on the outside of the heel (varus alignment) may experience increased pressure. Mechanical friction from stiff-backed shoes pressing on the bone leads to inflammation. Although the bony prominence requires surgical intervention to disappear, the painful symptoms are caused by the surrounding soft tissue inflammation it triggers.
A related structural issue is a calcaneal exostosis, or bone spur, an outgrowth of bone that forms where the Achilles tendon inserts. Unlike Haglund’s Deformity, an exostosis can involve calcification within the tendon substance, often due to chronic traction. These bony projections are a response to repeated stress and feel hard and unmoving, leading to localized pain during activities that stress the Achilles.
Inflammatory and Soft Tissue Bumps
Bumps that feel softer, spongy, or acutely tender usually indicate inflammation of the fluid-filled sacs or soft tissues surrounding the heel bone. The most common soft tissue cause is retrocalcaneal bursitis, which is the inflammation of the bursa located between the Achilles tendon and the calcaneus bone. When this cushion becomes irritated, it swells with fluid, creating a tender, noticeable mass.
Retrocalcaneal bursitis often occurs secondary to Haglund’s Deformity, where the bony prominence irritates the sac, but it can also develop independently from overuse or poorly fitting shoes. A separate condition is superficial Achilles bursitis, which involves the inflammation of the bursa located just under the skin at the back of the heel. Bursitis bumps are typically tender to the touch, and the area may appear red and warm due to the inflammatory process.
Other soft tissue lesions can present as heel bumps, though less frequently. Verrucae (plantar warts) are viral infections appearing as small, firm lesions on the sole of the heel that cause pain when pressure is applied. In rare cases, a bump may be a xanthoma, a soft, waxy lump near the Achilles tendon that is a deposit of fatty material, which can signal high cholesterol. Differentiation relies heavily on texture, location, and associated pain patterns.
Identifying Symptoms and Triggers
Distinguishing the cause of a heel bump involves careful observation of its location and texture. Bony bumps are hard and fixed, typically located on the upper-back portion of the heel near the Achilles attachment. Soft tissue bumps, like bursitis, are generally softer, sometimes fluctuating, and present with noticeable swelling and redness.
Pain patterns offer significant clues for identification. Pain caused by Haglund’s Deformity or associated retrocalcaneal bursitis is often worse when wearing rigid or tight-backed shoes that compress the area. The discomfort is usually localized to the back of the heel, aggravated by friction, and may involve tenderness along the Achilles tendon.
Triggers for these conditions are often mechanical and repetitive. Bony prominences are linked to inherited foot mechanics, such as a tight Achilles tendon or a high arch, which predispose the area to friction. Inflammatory bumps are commonly triggered by sudden increases in activity, repetitive stress from running, or the introduction of new, stiff footwear. A bump on the sole of the heel causing sharp, localized pain when stepped on is more consistent with a plantar wart.
Home Care and When Medical Attention is Necessary
Initial self-management for most heel bumps involves reducing inflammation and relieving pressure. Applying ice to the bump for 15 to 20 minutes several times a day helps reduce swelling and tenderness. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also be used temporarily to manage pain and inflammation.
Changing footwear is one of the most effective home adjustments to eliminate friction. This may mean switching to open-backed shoes, sandals, or athletic shoes with soft, padded heel counters. Using heel pads or orthotic inserts can also help by slightly elevating the heel to shift pressure away from the irritated area. Gentle stretching exercises for the calf muscles and Achilles tendon can prevent tightening, a common contributing factor.
You should seek professional medical attention if the bump does not improve after two weeks of consistent home treatment. Immediate consultation is necessary if you experience severe pain, sudden and significant swelling, or an inability to bear weight. Other red flags include signs of infection (fever, warmth, pus) or if the bump is accompanied by numbness or tingling. A physician can perform a physical examination and may use imaging, such as an X-ray, to determine if the bump is bony or soft tissue and rule out more serious underlying issues.