4 Tricky Causes Pain in The Back of Your Heel


Posterior Heel Pain

Posterior heel pain, or pain in the rear of the foot, is less common than pain under the heel. The location of the pain is at the back of the foot rising up the Achilles heel. The pain is most commonly caused when the Achilles tendon becomes inflamed or ruptures, with the pain felt directly over the affected part of the tendon, although the pain in the heel is often felt at the point where the tendon attaches to the heel bone (calcaneus). The causes are quite different to under the heel pain, although they may also be caused by heel spurs which have formed at the back of the foot.

Achilles tendonitis (Achilles tendinitis)

What Causes Pain in The Back of Your Heel, Achilles tendinitis

The Achilles tendon attaches the heel to the muscles in the leg, and its primary function is to help to raise the body up onto the toes and elevate the heel, which is particularly important for walking and running. The Achilles tendon is the largest in the body, and inflammation can be especially painful, making walking very difficult without support. Small tears can form in the tendon which can develop into a full rupture, so early diagnosis and treatment are vital. The condition does not necessarily always cause pain and is asymptomatic in many people. Similar to plantar fasciitis, the most intense pain is usually felt after a period of inactivity when the tendon tightens and takes time to relax and stretch. Pain first thing in the morning is common, and also after, or during periods of exercise. The condition is particularly common in athletes and those who walk and run frequently, although it can be caused by arthritis in the heel and is most common in the over 40’s.

The most common treatment is RICE, not the starchy grain, but the standard combination of Rest, Ice, Compression and Elevation. The early stages are treated with ice packs to limit the inflammation, whilst reducing activity to allow the tendon time to heal. After the acute phase has passed, stretching exercises are beneficial, and raising the heel can relieve painful symptoms, typically with the use of a 3/8 or 1/2 inch heel insert or orthotic device worn in the shoes.

Bone spurs and heel spurs

What Causes Pain in The Back of Your Heel, heel spurs

A bone spur, or heel spur, is a bony calcified growth around the tendons and ligaments, which is usually triggered by an injury. A heel spur is one of the defense mechanisms the body has in response to physical stress and injury. The problem takes time to develop and is common with those suffering from plantar fasciitis or tendonitis. The condition can be intensely painful or can be a dull and persistent ache, often made worse when the weight is placed on the feet. The pain is caused by inflammation of tissue around the spur, rather than from the spur itself, in particular at the point where the tendons join with the bone. Whilst it seems logical that the pain would worsen with activity, the reverse is the case. After periods of inactivity, the tendon tightens causing intense pain until the tendon and ligaments stretch. The pain is usually at its most intense after a long period of rest, such as in the mornings.

Retrocalcaneal bursitis

What Causes Pain in The Back of Your Heel, Retrocalcaneal bursitis

Bursitis is an inflammation of the bursa – a fluid-filled space which helps to lubricate the joints and also allows for the free movement of bone, tendons and the skin. Retrocalcaneal bursitis is the inflammation of the bursa at the back of the heel, where the Achilles tendon connects to the heel bone. It is considered in many cases to be an overuse injury and often accompanies Achilles tendonitis. The pain tends to be worse during activity and can cause a raised, inflamed lump at the back of the foot which is tender to the touch. It is best treated with RICE, with heel inserts particularly beneficial, and the inflammation controlled by over the counter NSAID’s such as Ibuprofen, with corticosteroid injections beneficial in the most severe cases.


What Causes Pain in The Back of Your Heel, Overpronation

The inward rolling of the foot when walking and running is called pronation, and whilst natural, can be excessive in many people, especially those with flat feet. As the foot rolls inwards, the efficiency of the stride is reduced, and abnormal pressures are placed on the feet which can lead to a wide range of problems. Correction of overpronation is best achieved with footwear, with many of the big name running shoe manufacturers producing shoes specifically to correct pronation and offer increased support and cushioning. The problem is commonly associated with flat feet and fallen arches.

What Causes Pain in The Back of Your Heel, Last Updated: 6/2/2018

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