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Posterior Heel Pain

by Paul A. Kammerlocher, MD

Do you have pain in the back of your heel? Do you have a bump on your heel that rubs your show? Have you gotten to the point that your walking is limited or you cannot stand a shoe on your heel at all? If so, then it is possible you ahve posterior heel pain.

Posterior heel pain is the second most common form of heel pain after plantar heel pain. Plantar heel pain is on the plantar surface (bottom) of the heel and is most commonly plantar fasciitis. Posterior heel pain is on the back of the heel and is most commonly associated with Achilles tendonn problems, such as degenerative Achilles tendonosis.

Degenerative Achilles tendonosis is a condition in which the collagen fibers that make up the Achilles tendon begin to break down. This breakdown is caused by mechanical stress over time. Just like a rope under excess tension, the small collagen fibers tear. When they do, the body tries to heal and often adds 'extra' material to the repair, creating a bump. As this occurs over time, becoming chronic, the bump and the pain grow.

The bump and pain of degenerative Achilles tendonosis most commonly occurs where the Achilles tendon attaches to the heel bone (calcaneus). It is the pain and the bump that usually brings the patient to the doctor because they cannot walk or wear a shoe. At this point it is often too late and surgery is the only option, but if treatment is started early, some symptoms can be avoided.

Early treatment for Achilles tendonosis is aimed at reducing stress on the tendon. This is best done by stretching the Achilles tendon and losing (any) extra weight. Heel cord stretches such as "runner's reach" and "hang ten" are the easiest to do, but should be done gradually and discontinued if they cause discomfort.

Other early treatments include heel lift or cup, over-the-counter anti-inflammatories (i.e., ibuprofen or Aleve®), night splints or even cast immobilization. If you are bothered by posterior heel pain and it doesn't improve quickly, contact us immediately. We will try to get you back on your feet!