Retrocalcaneal Exostosis (Heel Spur) Treatment in Los Angeles

What Is a Retrocalcaneal Exostosis?

A retrocalcaneal exostosis is an extra bone growth on the back of the heel bone (calcaneus), often referred to as a heel spur, though it differs from the spurs found on the bottom of the heel. This painful bony enlargement develops within the Achilles tendon and is directly influenced by the tendon’s length, elasticity, and overall function.

The Achilles tendon is a thick, powerful structure that connects the calf muscle to the heel bone. It allows the foot to move downward and propels the body forward when walking or running. The tendon functions like a rubber band, stretching with each step. When the tendon experiences excessive stress or tightness, it can trigger bone formation at its attachment site, leading to pain, inflammation, and difficulty with movement.

If you’re dealing with retrocalcaneal exostosis, it’s important to consult with a trusted podiatrist to diagnose your condition. The expert team at Foot & Ankle Specialty Group, led by the best heel spur doctor in Los Angeles, Dr. David J. Soomekh, stands ready to provide customized treatment options to get you long-term relief.

Signs and Symptoms of Heel Spurs

Heel spurs can cause persistent pain and discomfort, especially with movement. The symptoms often worsen over time and may be aggravated by certain footwear or activities.

• Deep, aching, or sharp knife-like pain at the back of the heel, especially when walking or engaging in activity
• Visible bony bump on the back of the heel, which may appear larger on days with increased irritation or swelling (bursitis)
• Significant pain with direct pressure over the bone
• Increased pain when taking the first few steps in the morning or after prolonged sitting, which may ease with movement but worsen again later in the day
• Discomfort when barefoot or wearing flat, unsupportive shoes due to increased strain on the Achilles tendon
• Friction from certain shoes, causing additional irritation and pain
• Gradual worsening of pain over time, with the potential for a bone spur fracture in cases of trauma or sudden movement
• Possible development of Achilles tendinitis due to continued bone growth and irritation of the tendon

Causes of Heel Spurs

Heel spurs form due to excessive stress and tension on the Achilles tendon, which stimulates extra bone growth. Over time, friction and repetitive strain can worsen the condition.

• Continuous pulling of a short or tight Achilles tendon on its attachment to the heel bone
• Increased bone growth triggered by prolonged pressure and friction, often aggravated by footwear
• Higher risk in individuals with naturally tight Achilles tendons, including those who habitually walk on their toes
• Wearing high heels for extended periods that can shorten the tendon and increase the likelihood of spur formation
• Ballet dancers who frequently go en pointe, placing excessive strain on the Achilles tendon
• Individuals with high arches (pes cavus), leading to an extra pull on the Achilles and increased bone formation

Diagnosing Heel Spurs

Diagnosing heel spurs involves a clinical examination and advanced imaging techniques. Dr. Soomekh uses the following methods:

• Patient consultation: Listening to complaints, symptoms, and treatment goals
• Hands-on examination: Assessing the foot and ankle, with a focus on the Achilles tendon and any tendon shortening or underlying causes
• Gait evaluation: Analyzing movement patterns to identify contributing factors
• Digital radiographs (X-rays): Taken in-office to assess the extent of the heel spur and extra bone formation
• CT scan (if needed): An in-office CT scan may be used to evaluate the heel bone and extra bone in 3D for a more detailed analysis

request appointment

Heel Spur Treatment Options

Dr. Soomekh recommends that early diagnosis and treatment of a retrocalcaneal exostosis are the keys to successful treatment, faster recovery, and a pain-free lifestyle.

Conservative Treatment for a Retrocalcaneal Exostosis

Conservative treatment for retrocalcaneal exostosis is limited. These treatments rely on their ability to decrease pain, reduce inflammation, stop the micro-tearing of the tendon, and stretch the tendon. Dr. Soomekh will recommend a strict two- to four-week initial therapy protocol. Reduction of inflammation and pain can be achieved by treating the area with a daily ice therapy regimen and anti-inflammatory medications (NSAIDs). A rest period will be needed to reduce the strain on the tendon and pressure on the exostosis while it is trying to heal. Heel lifts can be placed in the shoes to place some slack on the Achilles.

In most cases, a walking boot to restrict the pull of the tendon on the bone will be recommended. The patient will be educated on a calf and Achilles tendon stretching regimen. Stretching of the muscle/tendon complex is very important in order to elongate the complex, allow the tendon to be more elastic, and reduce the occurrence of micro-tears. These stretching exercises will be especially important in the mornings before getting out of bed or after a period of rest. Dr. Soomekh may recommend a course of visits to a physical therapist.

Custom Molded Orthotics

Custom-molded orthotics (insoles) are an integral part of healing and maintaining the integrity of the Achilles, as well as redirecting the pull of the tendon and the position of the extra bone formation. The pull of the tendon on the heel bone plays an important role in the support of the arch of the foot. When the tendon is damaged and irritated, the arch and the heel will need the added support of a custom orthotic to reduce the forces placed on the tendon while walking and increase activity. The orthotics control excessive motion through the heel during gait and take off some of the strain the tendon would normally incur.

These treatments have a high chance of failure because they do not reduce the extra bone. The extra bone formation causes most of the pain. At some point, this bone must be removed to alleviate pain.

Cortisone (Steroid) Injections

Dr. Soomekh does NOT recommend cortisone injections for retrocalcaneal exostosis. Steroid injections have many positive applications for the treatment of foot and ankle problems. However, the Achilles tendon can weaken when injected with cortisone.

Surgical Treatment for a Retrocalcaneal Exostosis

Dr. Soomekh will always recommend and attempt conservative treatment when appropriate. However, when a retrocalcaneal exostosis becomes chronically painful and activity is limited, surgical repair may be indicated.

Retrocalcaneal Exostectomy