Posterior Heel Pain Causes and Treatment

By Jonathan Cluett, MD
Updated August 14, 2019
Medically reviewed by a board-certified physician
a doctor holding a patient's foot

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Posterior heel pain can come from one of several causes. When a physician is talking about posterior heel pain, he or she is referring to pain behind the heel, not pain beneath the heel.

3 Sources of Posterior Heel Pain

Posterior heel pain, or pain behind the heel, is most commonly due to one of these causes:

  • Achilles Tendonitis: Achilles tendonitis is a common diagnosis of inflammation of the tendon in the back of the ankle. Most commonly pain is experienced directly over the tendon, but it may also be at the point where the tendon attached to the heel bone (the calcaneus). Degenerative changes such as small tears within the tendon and calcium deposits within the tendon can contribute to this problem.
  • Retrocalcaneal Bursitis: There are several bursae behind the heel bone that protects this area of contact. Often these bursae can become irritated leading to bursitis, inflammation and posterior heel pain.
  • Calcaneal (Heel Bone) Spur: A bone spur can form over a long period of time at the insertion of the Achilles tendon in the back of the heel. This bony prominence can grow over time, and is referred to as a "pump bump." This extra bone can irritate the surrounding tissues and lead to bursitis (see above) of the surrounding bursa.

Other causes of posterior heel pain that should also be considered include plantar fasciitis, stress fractures of the calcaneus, and os trigonum syndrome.

Diagnosis of the cause of posterior heel pain can be difficult as it is not uncommon for these diagnoses to coexist. For example, a patient with a bone spur of the calcaneus may have bursitis in that area as well. Because of this, all of these diagnoses must be considered for effective treatment of posterior heel pain.

Treatment

Most patients with posterior heel pain can find effective treatment through simple, nonsurgical treatments. It is important to understand the cause of the symptoms of pain before initiating any treatment program.

For example, a stress fracture may require crutches and limited weight on the extremity, whereas another problem may have no restriction on weight bearing. For this reason, treatment should only be initiated once the diagnosis has been made.

One of the most frequent treatments used for these conditions is gentle stretching of Achilles tendon and plantar fascia. By improving the mobility of the hindfoot, many of these conditions can be improved with a simple, non-invasive, non-medication treatment.

Pain Beneath the Heel

Pain beneath the heel is a different symptom from posterior heel pain. Pain underneath the heel, on the bottom of the foot, has several causes including:

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