Back of the Heel Pain: What Can Cause Pain in the Back of the Heel?
There may be quite a few causes because of which one experiences pain in the back of the heel. In some cases an individual may have an abnormal bony prominence which protrudes from the back of the heel which is a medical condition known as Haglund’s deformity which may cause back of the heel pain, especially when this deformity rubs against the Achilles tendon. This rubbing results in the bursa between the bone and tendon to get inflamed and swollen and this is what causes pain in the back of the heel.
Haglund’s deformity is not the only reason for this bursa to get swollen and inflamed but it can also be caused when the heel is tilted in such a way to cause the deformity to rub against the bone and tendon.
Some of the common causes for the tilting of the heel are:
Flat Feet: This is a condition in which the arch of the foot is flat. Due to this, the front part of the heel bone is tilted lower than what is the norm and the back part of the heel is tilted higher than what is the normal. Because of this, the back of the heel may be forced to rub into the achilles tendon and cause posterior heel pain or back of the heel pain.
High Arches: This is a condition in which the foot has high arches. This may give rise to Haglund’s deformity. Also an individual with high arches will have a heel bone which is tilted backwards into the achilles tendon. This results in the upper portion of the back of the heel to rub against the Achilles tendon and due to this irritation because of frequent rubbing there is inflammation of the bursa resulting in back of the heel pain.
Pronation: Pronation is a condition in which there is tilting of the foot in such a way that an individual is forced to ambulate with majority of the weight on the inner aspect of the heel and foot. Because of this, the Haglund’s Deformity rubs against the inner portion of the Achilles tendon causing pain.
Back of the Heel Pain: Medical Conditions That Can Cause Pain in the Back of the Heel?
The following are the medical conditions that usually cause back of the heel pain:
Haglund’s Deformity: Also known by the name of Pump Bump this is a bony deformity on the back of the heel which results in inflammation of the bursa causing pain in the back of the heel.
Retrocalcaneal Bursitis: This is a medical condition in which there I inflammation of the retrocalcaneal bursa. The retrocalcaneal bursa is a protective sac which lies between the heel bone and the Achilles tendon. When this bursa becomes inflamed or swollen it results in back of the heel pain.
Achilles Tendonitis: This is a condition in which there is inflammation of the Achilles tendon which results in pain in the back of the heel.
What are the Symptoms Accompanied With Pain in the Back of the Heel?
Back of the heel pain is most of the times accompanied by tenderness and swelling of the heel on palpation. There is also presence of erythema on the affected heel. Individuals with pain in the back of the heel will find it difficult to ambulate normally. In chronic cases of pain in the back of the heel, the individual will find it difficult to raise the affected leg.
What are the Treatments for Pain in the Back of the Heel?
The treatment for pain in the back of the heel is basically conservative, although surgery is sometimes necessary to relieve back of the heel pain. Some of the conservative treatments used for pain in the back of the heel are:
Heel Lift: If an individual with pain in the back of the heel walks with a flat-soled shoe it increases the pressure on the Achilles tendon insertion and thus increases the discomfort. Hence using a heel lift or a shoe with a moderate heel goes a long way in reducing the stress on the Achilles tendon and hence reduce the pain in the back of the heel.
Calf Stretching: Regular calf stretching also tends to improve the length of the Achilles tendon and makes it stronger and less likely to wear easily with repetitive activities of daily living.
Nonsteroidal Antiinflammatories: Use of NSAIDs can help reduce the back of the heel pain and inflammation in the retrocalcaneal bursa.
Weight Loss: It has been noted that majority of people complaining of pain in the back of the heel tend to be obese or overweight. Weight loss by healthy means will put less pressure on the heels and thus will help relieve back of the heel pain.
Casting: This is another way of treating pain in the back of the heel. This is usually done for individuals who have a chronic complaint of pain in the back of the heel. A walker boot can also be used. Casting is done usually for a period of six weeks to allow the inflammation to calm down.
In case if conservative treatment fails to improve the symptoms of back of the heel pain, then surgery is the route to go. Surgery may lead to longer recovery periods and unexpected complications. Surgery is usually recommended for athletes who develop Haglund’s deformity and surgery involves removal of the inflamed retrocalcaneal bursa and debriding the Achilles tendon to relieve back of the heel pain.
When it comes to recovery period of back of the heel pain after surgery, it is usually prolonged and the patient is immobilized for a period of about four weeks to allow the wounds to heal. After that, the patient is started on range of motion exercises. It usually takes around six weeks before the patient can start full weight bearing on the extremity and get relief for Pain in the Back of the Heel.
- American Academy of Orthopaedic Surgeons. (2021). Achilles Tendinitis. OrthoInfo https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/