Treatment Tips for Pain in the Back of the Heel

By Larry Huppin, DPM and Doug Hale, DPM 

Many people experience back of heel pain where there is swelling and a sore heel in one or both feet. When this happens, the back of the fott hurts when walking, running, or standing. A person may notice a bump at the back of the calcaneus, swelling and enlargement of the heel bone, and an area that is tender to the touch. Pain is most likely due a common cause, which include Haglund's deformity (a "pump bump" or bump on the heel bone), Achilles tendonitis (swelling in this tendon), Achilles Calcific Insertional Tendonitis (increased bone formation where the Achilles attaches into the heel bone) and Retrocalcaneal bursitis (a fluid filled sac). In each of these foot conditions there may be swelling and inflammation with posterior heel pain. Some people walk with a limp due to severe heel pain or find it hard to take longer strides.

Steps to Eliminate Back of Heel Pain
If you suffer from this problem, it's important to make every effort to treat it conservatively. In most cases, it's possible to avoid surgery, which has long recovery times and risks of complications. Here are some suggestions to try:

Wear the right shoes: Tight shoes or high heels can contribute to severe heel pain, so avoid these types of shoes. The shoe pressure often makes the pain worse and can even make it harder to stand or move. Instead, a roomy shoe with a slight to moderate heel lift is a better choice. These shoes help reduce the stress on the tendon. Also, avoid walking in bare feet and wearing flat-soled shoes.

Use custom orthotics: Several studies have shown that custom orthotics helps people who have back of heel pain. Custom orthotics are fitted to the foot and inserted into the shoe for a better fit and alignment of the heel. These devices can decrease tension or a "twist" on the Achilles tendon.

Stretching and strengthening exercises: The calf muscle and Achilles tendon area should both be stretched on a regular basis. There are also specific types of strength exercises to try. A podiatrist can help determine whether strengthening the Achilles tendon might be beneficial.

Wearing a walking boot: This device is for severe morning pain to help calm the area. It keeps the foot immobilized for a short period of time.

Anti-inflammatory medications: If posterior foot pain is a problem, anti-inflammatory medications can temporarily reduce the swelling. While this treatment doesn't cure the underlying problem and should be used short-term, it will make the pain more tolerable. After that, a treatment plan can be developed with a podiatrist.

Lose weight: Losing weight can be the most effective treatment. This is because carrying extra weight causes the Achilles tendon to experience forces equivalent to many times body weight during regular, daily activities. If weight loss is a likely cause of posterior foot pain, make a concerted effort to work with a nutritionist, trainer or doctor to take off the pounds.

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