Painful bony prominence at posterior superior aspect of the calcaneus – usually associated with a bursitis. Prominence may be a normal variant that is irritated by shoes bursitis – the bursitis may be an inflammation of the bursa deep or superficial to the tendo Achilles (deep bursa is banana or “boomerang” shape, resting on calcaneus.
Prominence of posterior, superior. lateral aspect of calcaneus
Pain and tenderness – exacerbated by shoes. If deep bursa is involved may be painful on dorsiflexion.
Fowler-Philip angle is usually >75 degrees
Normally have a 2mm radiolucent area between achilles tendon insertion and calcaneus – if this is lost inflammation of bursa
Differential diagnosis – insertional achilles tendinosis; achilles tendonitis; rheumatoid arthritis; seronegative arthritis.
Heel lift (to raise prominence above counter of shoe); accommodative padding to relieve pressure; use of shoes with heel counter modified to apply no pressure in area; steroid injections into bursa; aspiration of bursa; control of excessive rearfoot motion if present
Foot orthoses with posteriorly extended heel post to move shoe counter away from foot.
Removal of inflamed bursa and resection of bony prominence
Wedge osteotomy of calcaneus to change pitch/angle of calcaneus