The question of whether a true bunion can form on the heel stems from common confusion regarding bony lumps on the feet. While “bunion” is often used generally to describe any painful, visible bump, medically it refers to a specific anatomical issue. A bunion is a structural deformity that occurs in the forefoot, the front portion of the foot, far removed from the heel. Therefore, a lump on the heel, while possibly a bony prominence, cannot be a bunion.
Where True Bunions Form
A true bunion, medically known as Hallux Valgus, is a progressive deformity centered at the base of the big toe. It involves the first metatarsophalangeal (MTP) joint, which connects the first long foot bone (metatarsal) to the first toe bone (phalanx). The characteristic bump forms because the metatarsal bone shifts inward while the big toe simultaneously drifts outward toward the smaller toes.
The resulting prominence on the inner side of the forefoot is the misaligned head of the metatarsal bone. This bony protrusion is often accompanied by an inflamed, fluid-filled sac called a bursa, which becomes irritated by friction from footwear. This misalignment defines a bunion, establishing its location firmly at the junction of the toe and the foot.
The Heel Deformity Often Confused with a Bunion
The bony lump often mistakenly called a “bunion on the heel” is most frequently identified as Haglund’s deformity. This condition involves an abnormal enlargement of the calcaneus, the bone on the back of the heel. The bony overgrowth occurs near the attachment point of the Achilles tendon.
Haglund’s deformity is commonly referred to as a “pump bump” because rigid shoe backs, such as those found in pumps or dress shoes, often aggravate it. Shoe pressure irritates the retrocalcaneal bursa, a small fluid sac between the Achilles tendon and the heel bone. Chronic irritation leads to bursitis, which contributes to painful swelling and the visible bump on the back of the foot.
The difference between Haglund’s deformity and a bunion is based entirely on location and the affected structure. A bunion is a structural problem of the big toe joint, whereas Haglund’s deformity is a bony growth on the calcaneus that irritates adjacent soft tissues and tendons. Haglund’s is the bump most closely resembling a surface prominence like a bunion, though other growths like calcaneal spurs can also form on the heel bone.
Treating Bony Prominences on the Heel
Treatment for a painful bony prominence on the heel, such as Haglund’s deformity, focuses on conservative methods to reduce inflammation and pressure. The first step is shoe modification, involving avoiding footwear with rigid heel backs and choosing soft-backed or open-backed styles. This change significantly reduces the friction that causes irritation and pain.
Applying ice to the inflamed area for 15 to 20 minutes several times daily helps diminish swelling and discomfort. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to manage pain and reduce inflammation. Physical therapy is also used, involving stretching exercises to alleviate tension in the Achilles tendon, which contributes to pressure on the heel bone.
For structural relief, a podiatrist may suggest heel pads, heel lifts, or custom orthotic devices placed inside the shoe. These inserts cushion the heel or change the foot’s position to relieve stress on the bony area. If conservative strategies fail, surgical removal of the bony prominence may be considered as a last resort.