Pain in the Back of the Heel- What could it be?

Heel pain is a problem affecting many people, with pain in the back of the heel being one of the most common complaints.

What causes pain in the back of the heel?

Pain in the back of the heel is most commonly attributed to the Achilles tendon and its associated structures. Whilst the heel pain may be caused by injury, it is uncommon. In most cases, pain develops due to overuse or repetitive strain. Some of the more common causes of pain in in the back of the heel are detailed below.

What is the Achilles tendon?

The Achilles tendon functions to facilitate walking by causing the heel to lift up and the toes to point downwards, hence when it becomes irritated or injured it can be the source of pain at the back of the heel. The Achilles tendon is the strong, cord-like structure that runs down the back of your lower leg, attaching your calf muscles (namely the plantaris, gastrocnemius and soleus) to your heel bone (the calcaneus). At the point where the Achilles tendon inserts into the heel bone, there are some associated soft tissue structures known as bursae, which are little fluid filled sacs that reduce friction between bone, tendon and skin. When these become irritated or injured, they can also cause pain in the back of the heel.

Pain in the back of the heel caused by Achilles tendonitis:

Achilles tendonitis is the most common condition that causes pain in the back of the heel. The condition is characterized by the inflammation of the Achilles tendon.

Symptoms: dull and achy or sharp and sudden pain that can occur during or immediately following exercise, throughout the day, tightness and burning sensations, difficulty walking uphill or flexing the foot, swelling, redness or warmth.

Risk factors: increasing age, flat feet / high arches and tight calf muscles, playing sports that require fast directional changes or rapid acceleration, wearing poorly fitting shoes or high heels for extended periods.

Pain in the back of the heel caused by Haglund’s syndrome:

Haglund’s syndrome is also referred to as a ‘pump bump’. It causes pain in the back of the heel, usually when tight shoes rub against the bony prominence at the back of the heel bone.

Symptoms: pain at the back of the heel, around the bony part of the back of the heel, associated with swelling, warmth and redness.

Risk factors: wearing tight fitting shoes, especially that are tight around the back of the heel, having feet with high arches, and possible hereditary.

Pain in the back of the heel caused by bursitis:

Bursitis, another condition that can cause pain the back of the heel, is the inflammation of the fluid-filled sacs that are located between tissues to reduce friction in those areas. There are two types of bursitis that are commonly associated with pain in the back of the heel: retrocalcaneal bursitis and calcaneal bursitis. Both types of bursitis can be present in association with Achilles tendonitis or Haglund’s syndrome.

Symptoms: retrocalcaneal bursitis causes deep pain in the back of the heel and difficulty walking or wearing enclosed shoes. Swelling, stiffness, redness and warmth are localized to begin with, but as the condition progresses, the swelling may extend to the sides of the heel. Calcaneal bursitis causes pain in the back of the heel that feels like it is on top of your Achilles tendon. Swelling, redness and warmth are common, and as the condition progresses, the top layer of skin may wear away and a painful, visible nodule may form.

Risk factors: wearing tight fitting shoes such as high heels and suffering with Haglund’s syndrome are risk factors for calcaneal bursitis. Any activity or condition that puts extra strain on the Achilles tendon, injuries to the heel, and some medical conditions (such as rheumatoid arthritis and gout) can contribute to the development of retrocalcaneal bursitis.

Diagnosing and treating pain in the back of the heel

Your sports podiatrist will conduct a thorough examination in order to determine the cause of your pain in the back of the heel. Their examination will include a comprehensive history-taking, physical examination, and in some cases diagnostic imaging to assist them in excluding alternative diagnoses.

Treatment for your pain in the back of the heel will be entirely based on your diagnosis. Treatments for the above-mentioned conditions tend to be aimed at reducing inflammation and relieving strain on the tendon / pain. Your treatment plan is likely to include a number of different methods. Some of the treatment options that your sports podiatrist may incorporate include:

• Ice and elevation
• Shockwave therapy
• Footwear changes
• Stretching techniques.
• Heel wedges inside the shoes

Please be informed that the article about pain in the back of the heel, which is detailed above is for educational purposes only. It is not intended to be, nor should it be taken as general medical advice. If you have pain in the back of the heel, you should consult with a professional sports podiatrist, who will be able to offer an accurate diagnosis and suitable treatment plan for your condition. Appointments can be made with our specialist podiatrists by emailing [email protected] or by calling 0293883322.

Karl Lockett – sports podiatrist.