Posterior Heel Pain – Part.1


Posterior Heel Pain

Posterior heel pain (pain localized to the back of the heel) can be caused by a variety or combination of different sources.  This pain can greatly affect your everyday life, both physically and mentally. Simple acts such as walking or climbing stairs can be  very difficult and painful.

What are the causes and symptoms of posterior heel pain?

Heel pain can occur suddenly or over a gradual period of time. There are many variables that need to be considered when diagnosing not only the type of injury that is causing the heel pain, but also the reason behind why this pain occurred initially.

Listed below are some of the most common causes of posterior heel pain and their associated symptoms:

Plantar Fasciitis


  • Plantar fasciitis: Degeneration of the plantar fascia connective tissue of the foot.
    • Cause: Overuse and repetitive movements that overstretch the connective tissue underneath the foot, the plantar fascia. The plantar fascia joins from the sole of the foot to the bottom of the heel, or calcaneus bone.
    • Symptoms:
      • Pain is most severe in the morning
      • Tenderness is felt on the underside and medial point of the calcaneus bone
      • Pain sometimes refers down the tendon to the soles and along the arch of the foot
    • Sever’s disease: Rapid growth spurts that over stretches connective tissue.
      • Cause: A disease commonly seen in active children between 8 and 15 years of age going through growth spurts that cause their bones to grow at a faster rate than their connective tissues, such as muscles and tendons. When attached to the bone, these connective tissues have an increased level of stress placed on them, especially during exercise, generally resulting in inflammation and pain.
      • Symptoms:
        • Pain, redness and tenderness at the posterior part of the heel
        • Sometimes a lump is seen at the posterior part of the heel
        • Pain felt when locomoting and if the sides of the heel are pressed
        • A limp or walking on tip toes may occur to avoid walking on the heel
      • Bruised heel: Bruising of the calcaneus bone due to overuse or sudden impact.
        • Cause: Bruising of the heel occurs as a result of a misplaced or degenerated pad of fatty tissue. Which combined with a sudden impact on the heel or repetitive overuse, can cause bruising and pain on the bone.
        • Symptoms:
          • Heel pain which increases with movement
          • The heel will be tender to touch

Achilles Tendonitis

  • Insertional achilles tendonitis: Inflammation of the achilles tendon at the heel.
    • Cause: Inflammation of the achilles tendon at the insertional point on the calcaneus bone is commonly caused by overuse, however it can also become a chronic recurring injury. This is especially true for athletes with a high training volume or in children between 8 and 15 years of age experiencing a growth spurt resulting in sever’s disease.
    • Symptoms:
      • Inflammation of the tendon where it inserts onto the back of the heel
      • Painful and tender to touch
    • Achilles bursitis: Inflammation of the bursa caused by repetitive impact.
      • Cause: The achilles bursa, or retrocalcaneal bursa, is located between the calcaneus heel bone and the achilles tendon and acts as lubrication to allow smooth movement to occur over the bone. Such as for long distance runners, repetitive impact on the heel can result in inflammation of the bursa due to friction created between the tendon and bone.
      • Symptoms:
        • Posterior heel pain
        • Inflammation and tenderness of the heel
        • When palpated from the side of the calcaneus, the bursa’s sponge like material can be felt protruding sometimes
        • Pain felt is felt more aggressively when running up a heel or on soft surfaces when the friction around the bursa is increased. This is due to increased braking forces when running uphill, and the increased use of the achilles tendon and attaching muscles required to run on soft surfaces. As an example, running on sand in comparison to running on a hard flat surface, requires 1.6x of the energy demands to execute the running motion.

Haglund’s Deformity

  • Haglund’s syndrome: Both achilles bursitis and insertional achilles tendonitis.
    • Cause: Haglund’s syndrome occurs when both achilles bursitis and insertional achilles tendonitis are present in the same leg. Sometimes this may lead to Haglund’s deformity, which is a bump-like benign cartilaginous growth that forms on the posterior part of the calcaneus bone. This deformity usually occurs in the feet of people who wear tight and stiff shoes that put pressure on the heels, such as high heels. It can also sometimes be caused by biomechanical abnormality, such as a high foot arch when locomoting.
    • Symptoms:
      • A bump-like structure at the posterior part of the heel
      • Inflammation, tenderness and pain felt around the heel
      • Pain felt when locomoting, especially when extra pressure is placed on the heel or achilles tendon and attaching muscles

In Part 2 of Posterior Heel Pain, we will be further exploring the injuries associated with posterior heel pain and the development, treatment and prevention of them.

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