Pain at the back of the heel or the back of the ankle can make walking, climbing stairs, and wearing shoes difficult. The cause is often the Achilles tendon, a bony bump on the heel, or both. Our foot and ankle team will pinpoint where the pain is coming from and treat it.
Our foot and ankle team sees patients for back of heel pain at our office in Exton, PA, conveniently serving patients from Downingtown, Chester Springs, Malvern, and West Chester.
Pain on the bottom of the heel instead? See our Heel Spurs page.
What causes pain at the back of the heel
The Achilles tendon connects the calf muscles to the back of the heel bone. Several problems can affect this area:
- Achilles tendonitis (midportion): irritation and thickening of the tendon a few inches above the heel, often from overuse.
- Insertional Achilles tendonitis: pain where the tendon attaches to the heel bone. Calcium deposits or a bone spur can form inside the tendon at this spot.
- Haglund’s deformity (“pump bump”): a bony enlargement on the back of the heel that rubs against shoes and the tendon.
- Bursitis: inflammation of the fluid-filled sac between the tendon and heel bone.
Common causes
- A sudden increase in running, walking, or sports
- Tight calf muscles
- Shoes with a stiff or high back that presses on the heel
- Foot shape and mechanics, such as high arches
- Age-related changes in the tendon
What you might feel
- Pain or stiffness at the back of the heel or above it, often worse in the morning
- A visible or tender bump on the back of the heel
- Swelling or thickening of the tendon
- Pain that worsens with activity, stairs, or shoes that rub
Our treatment approach
We examine the tendon and heel and use X-rays, and sometimes ultrasound or MRI, to see exactly what is involved.
Conservative (non-surgical) care
- Rest and activity changes
- Calf stretching and specific strengthening exercises
- Heel lifts, open-back or soft-back shoes, and orthotics
- Anti-inflammatory medication and ice
- Immobilization in a walking boot when needed
- Physical therapy
Surgical options
If pain continues after a full course of conservative care, surgery may be recommended. Depending on the problem, this can include removing the bony bump or spur, removing calcium deposits and damaged tendon tissue, and repairing or reattaching the tendon. When appropriate, we use minimally invasive surgery techniques in our own surgery center. We review risks, benefits, and recovery with you before deciding.
When you should contact us
- Back of heel or Achilles pain lasting more than a couple of weeks
- A growing or painful bump on the back of the heel
- Swelling or a thickened tendon
- Pain that limits walking, work, or exercise
- A sudden pop or sharp pain at the back of the ankle. This may be an Achilles rupture and should be seen right away.
Get back on your feet
We will find the source of your back of heel pain and build a plan that fits your activity and goals. Same-day appointments are often available.