Upper Heel Pain – What could be the problem?

Upper Heel Pain is a Common Complaint

Heel pain is one of the most common reasons for which patients are seen at the sports podiatrist, with upper heel pain constituting a large proportion of those cases. Upper heel pain can be frustrating and inconvenient, and if not diagnosed accurately and managed correctly, can lead to debilitating and chronic pain.

What Causes Upper Heel Pain?

Upper heel pain is the pain that can be felt at the upper part of the back of the heel. Sometimes it is also described as posterior heel pain. In this area of the heel there are a number of soft tissue structures that may become irritated over time, or even injured suddenly, leading to inflammation and heel pain.

The Achilles tendon and its associated structures are most commonly at the root of the cause of upper heel pain in patients. The pain can sometimes be caused by injury, but it is fairy uncommon. In most cases, the heel pain is due to overuse or repetitive strain on the tendon and the surrounding structures.

What is the Achilles Tendon and How it is Related to Upper Heel Pain?

The Achilles tendon’s job is to facilitate walking by lifting the heel and causing the toes to point down as the calf muscles contract; hence, if it becomes damaged, it can cause upper heel pain. The Achilles tendon is a long, strong and fibrous cord of tissue that runs along the back of the lower leg and connects the calf muscles (plantaris, gastrocnemius and soleus) to the heel bone (the calcaneus). The Achilles tendon attaches at a particular point on the heel bone, and around this attachment point there small, fluid-filled sacs known as bursae. The bursae function to reduce friction between the bone, tendon and skin. If bursae become injured or irritated, they can also be a significant cause of upper heel pain and stiffness.

Upper Heel Pain may be caused by Achilles Tendonitis

In most cases, upper heel pain is caused by Achilles tendonitis. Achilles tendonitis is a condition where the Achilles tendon becomes irritated and inflamed.

 Symptoms: varying sensations of upper heel pain, ranging from dull aching to sharp stabbing pain that is present at the beginning/ during and/or immediately following exercise. The patient usually has great difficulty walking uphill and flexing their foot, and there may be swelling, redness or warmth present in the area.

 Risk factors and causes: increasing age of the patient, having flat feet, poor flexibility in the calf muscles, wearing poorly fitting shoes or high heels for long period of time, playing sports that require the athlete to accelerate rapidly or make fast directional changes. These things can all lead to upper heel pain.

Upper Heel Pain caused by Haglund’s Syndrome

Haglund’s syndrome causes upper heel pain and is common in women. It is also known as a ‘pump bump’ since it usually develops when tight shoes restrict the back of the heel, causing a swollen ‘bump’ to form.

Symptoms: upper heel pain that is localised to the bony upper part of the back of the heel bone, the presence of a swelling and redness and warmth.

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

Upper Heel pain caused by Retrocalcaneal Bursitis

Bursitis occurs when the bursae become inflamed due to overuse or excessive friction. Retrocalcaneal bursitis describes the inflammation of the bursa between the Achilles tendon and the heel bone.

Symptoms: the upper heel pain and stiffness that is felt is usually described as being ‘deep’. The patient will likely have difficulty wearing enclosed shoes and pain with walking. There is usually localised swelling, but if left untreated, the inflammation can spread to cause swelling around the sides of the heel as well.

Risk factors and causes: activities or conditions that put strain on the Achilles tendon, heel injuries, rheumatoid arthritis and gout are all possible risk factors that can contribute to the development of retrocalcaneal bursitis.

Upper Heel Pain caused by Calcaneal Bursitis

Calcaneal bursitis causes upper heel pain that is commonly felt as a superficial (closer to the skin) pain. It occurs when the bursae that is located between the Achilles tendon and the skin becomes inflamed.

Symptoms: superficial upper heel pain, otherwise described as feeling it is on top of the Achilles tendon, with swelling, redness and warmth. If left untreated, over time a painful nodule can form and the top layers of skin can begin to peel off.

Risk factors and causes: having Haglund’s deformity, wearing tight fitting shoes.

Treating Upper Heel Pain

Before your upper heel pain can be treated, your sports podiatrist will need to make a diagnosis. This is based on pain symptoms, other clinical signs, biomechanical assessment and gait analysis and occasionally may involve diagnostic imaging. The treatment for your upper heel pain will depend entirely on the diagnosis. Whilst different treatment methods may be recommended for the different causative conditions, the treatment will generally be aimed at reducing inflammation and relieving your upper heel pain, while maintaining good calf range and supportive shoes with a small to substantial heel.

Please be advised that the information regarding upper heel pain provided in the article above should not be taken as general advice. It is for educational purposes only. If you have upper heel pain, you should consult with a qualified sports podiatrist for an accurate diagnosis and treatment plan. You can make an appointment with one of our specialist podiatrists by emailing [email protected] or by calling 0293883322.

Karl Lockett – sports podiatrist.