Did you know that many people suffer from back heel pain? If you’re experiencing pain at the back of your heel, and it doesn’t get better with home care, then you should seek medical help because it can lead to severe complications. Learn what causes back heel pain and treatment options in this article. Log on to www.doralhw.org for a consultation.

Causes

Many conditions cause back of heel pain or posterior heel pain:

1. Calcaneal apophysitis (Sever’s disease):

Children and adolescents between 8 and 14 years old develop this disease that causes back heel pain. It occurs when excessive tension and stress are put on the calcaneal apophysis (the growth plate area of the heel bone) leading to inflammation and irritation in this area. Many patients may complain about pain in one or both heels. It makes them feel like they have a constant bruise which gets worse with exercise. Any child may develop this disease, but it is most common in children who participate in sports in which lots of jumping is required like basketball, volleyball, or gymnastics.

2. Achilles tendonitis:

In adults, back heel pain is mostly caused by Achilles tendonitis. This occurs when the Achilles tendon of the lower leg gets irritated and inflamed due to intense or repetitive strain on the tendon. Patients describe this back heel pain as uncomfortable and limiting the range of motion of their ankle or tightening their calf. Sometimes they also notice signs like redness, swelling, heat in the back of the heel, and stiffness.

3. Haglund’s deformity (Pump Bump, retrocalcaneal exostosis):

This is also a common condition that causes back heel pain. In medical terms, this condition is popular as ‘pump bump’ or retrocalcaneal exostosis. It occurs when you develop an abnormal bony heel spur in the back of the heel bone, at the insertion point of the Achilles tendon. This irritates or inflames the soft tissues in the area where bone spur rubs against any tight-fitting or rigid shoes. This condition mostly occurs in middle-aged females, but males also get affected. A painful enlargement is mostly visible at the heel back and the pain gets worse after some rest.

4. Achilles tendon bursitis (retrocalcaneal or retro Achilles bursitis):

This condition occurs when the bursae (flat, fluid-filled sacs that provide cushioning and lower friction in areas where muscles, tendons, and ligaments contract over bone) in the posterior area of the calcaneus become inflamed or irritated, which leads to back heel pain. This is called bursitis. It has two types:

• Retrocalcaneal bursitis: This occurs when inflammation of the bursa happens between the Achilles tendon and the heel bone. It is typically caused by uphill running, or in association with Haglund’s deformity, as these cause constant irritation and pressure on the bursa.
• Retro Achilles bursitis: This occurs from the inflammation of the bursa between the Achilles tendon and the skin. It is caused when footwear digs into the heel back.

Sometimes both these types of bursitis occur together.

Symptoms

If you get an injury or problem with the heel, here are some common signs and symptoms you may experience:

5. Stabbing heel pain:

This is a common body response to an injury or inflammation of any heel structures, whether the Achilles tendon, heel bone spur, or plantar fascia. This type of pain generally increases with movement and may or may not get better with rest.

6. Pain while walking on your tiptoes:

Walking on your tiptoes is called plantar flexion which requires activation of your calf muscles and also the Achilles tendon. So, any injury or inflammation of the calcaneus or the Achilles tendon will cause pain during toe walking.

7. Warm skin over the calcaneus:

This is a sign of inflammation that occurs when the skin over the calcaneus gets red, warm, and tender to the touch. This may or may not be accompanied by swelling but the affected area will be warmer than the rest of the foot.

8. Swelling:

This is another sign of inflammation accompanied by heel bone fractures. If there’s persistent swelling despite ice therapy on the heel bone, your physician will diagnose it. Swelling in the foot occurs due to injury to the muscle, bone, and supporting ligaments.

9. Tingling and burning pain:

The feeling of tingling, decreased sensation, or burning pain in the heel indicates some sort of nerve entrapment or nerve injury. This is commonly seen in conditions like neuritis and tibial tarsal syndrome.

Treatment

Back heel pain treatment initially focuses on relieving the symptoms with conservative care. It includes:

• Pain medications such as over-the-counter medications.
• Comfortable supportive shoes that reduce the pressure on your heel.
• Steroid injection to reduce inflammation on the bursa.
• Stretch exercises for the calf muscles.
• Orthotics – depending on your foot type, it is advised you use a non-bespoke insole, and, in some cases, you may refer to the podiatrist for bespoke orthoses.
• Silicone gel sheeting to reduce the pain.
• Extracorporeal shockwave therapy: This treatment focuses on improving healing at the tendon-bone junction. However, only some studies report long-term success from this treatment; however, it appears more helpful when combined with calf stretch exercises.

In case your pain doesn’t get better with conservative care, your doctor might recommend surgery. The type of surgery depends on your condition. Here are the most common surgeries used to treat back heel pain:

10. Bony exostosis removal:

In this surgery, the outgrowth bone is removed from the heel back along with any that grew into the Achilles tendon. Then the tendon is reattached to the bone with the help of an anchor suture (a stitch into the bone). If needed, the inflamed bursa can also be removed.

11. Removal of bony bump:

In this surgery, a cut will be made on the heel back near the Achilles tendon to remove a bump of bone from the foot. Some of the Achilles tendons may be detached as well to ensure the bony lump will be removed completely and then reattached.

12. Osteotomy:

In this surgery, the doctor cuts the heel side to expose the heel bone and removes a small section of bone to reduce the pressure at the heel back. The doctor then uses screws to hold the bone together while it heals. The screws stay in your heel bone unless they cause problems. If they do, you can get them removed with another operation.

13. Bursa removal:

In this surgery, the doctor may remove your inflamed bursa during diagnosis with surgery to treat the bony outgrowth.

14. Lengthening of the calf tendon:

In this surgery, the doctors cut the calf back and position it correctly so that it wouldn’t get tight and cause back heel pain. There are two techniques used to lengthen the calf tendon, Strayer’s, and Baker’s techniques. However, this surgery may make calf muscle weaker or rarely make the sural nerve irritating which leads to numbness or hypersensitivity to the lower leg.

Back heel pain is a common condition that occurs due to different foot injuries or problems that strain or pressure the back heel tendon or bone. Like other foot problems, it is treatable with conservative care or surgery. However, if you delay your treatment or ignore the pain it may lead to severe complications. So, be aware of the signs of back heel pain and seek treatment.

Need help with back heel pain or any other foot problems, visit our podiatry clinic in Brooklyn to get professional medical help. Call us to book your appointment now to ensure faster pain relief and prevent complications!!!!

Doral Health & Wellness employs Podiatrists with extensive education and expertise. Trauma to the tendons, muscles, and bones of the foot is quite common, as are infections secondary to systemic diseases. It’s not a promising idea to put off seeing Foot Doctor Brooklyn until you’re in a lot of pain. Our address is 1797 Pitkin Avenue, New York, NY 11212. To make an appointment, please call +1-347-384-5690 or send an email to info@doralhw.org.