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Posterior Heel Pain

Common causes of heel pain

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Updated June 02, 2014

What are the common causes of posterior heel pain?
Posterior heel pain can come from one of several causes. When a physician is talking about posterior heel pain, he or she is referring to pain behind the heel, not below it. Pain underneath the heel, on the bottom of the foot, has several causes including:

Pain over the posterior part of the heel is commonly due to:

  • Achilles Tendonitis
    Achilles tendonitis is a common diagnosis of inflammation of the tendon in the back of the ankle. Most commonly pain is experienced directly over the tendon, but it may also be at the point where the tendon attached to the heel bone (the calcaneus). Degenerative changes such as small tears within the tendon and calcium deposits within the tendon can contribute to this problem.

  • Retrocalcaneal Bursitis
    There are several bursa behind the heel bone that protect this area of contact. Often these bursa can become irritated leading to bursitis, inflammation and posterior heel pain. Treatment of bursitis is covered in the article describing bursitis.

  • Calcaneal (Heel Bone) Spur
    A bone spur can form over a long period of time at the insertion of the Achilles tendon in the back of the heel. This bony prominence can grow over time, and is referred to as a "pump bump." This extra bone can irritate the surrounding tissues and lead to bursitis (see above) of the surrounding bursa.

How is posterior heel pain diagnosed?
Diagnosis of the cause of posterior heel pain can be difficult as it is not uncommon for these diagnoses to coexist. For example, a patient with a bony spur of the calcaneus may have bursitis in that area as well. Because of this, all of these diagnoses must be considered for effective treatment of posterior heel pain. Other causes of posterior heel pain that should also be considered include plantar fasciitis, stress fractures of the calcaneus, and os trigonum syndrome.

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