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Pain in the back of the heel can have several causes.
The most important cause is a "defective" attachment of the achilles tendon to the back of the heel. Basically there is too much side to side motion between the heel bone and the attachment of the achilles and that sets up an area of inflammation. The body tries to stabilize the area and lays down extra bone but the excess bone often causes one to feel a lump and is termed Achilles Insertional Calcific Enthesopathy or AICT.
Treatment may include physical therapy to calm down the inflammation and stretch any tightness out of the achilles. An orthotic (shoe insert) with a deep heel cup may be used as it serves to decrease the side to side motion and protect the area.
Unlike pain on the bottom of the heel, surgical treatment may be needed more often for this problem and is easier and more successful. The achilles is pulled back annd any excess bone cleaned off the back of the heel bone and then the achilles re-attached. Sounds like a big deal but modern technology has provided us with some great tools such as bone anchors which may the re-attachment of the achilles strong, easy -- the goal is to have an achilles that moves less against the heel bone once healed.
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