Orthopedics Leg, Foot & Ankle Causes of Pain Posterior Heel Pain Causes and Treatment By Jonathan Cluett, MD Updated on May 17, 2022 Medically reviewed by Yaw Boachie-Adjei, MD Print 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 pain beneath the heel. Henglein and Steets / Getty Images 3 Sources of Posterior Heel Pain Posterior heel pain, or pain behind the heel, is most commonly due to one of these causes: 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 bursae behind the heel bone that protects this area of contact. Often these bursae can become irritated leading to bursitis, inflammation and posterior heel pain. 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. Other causes of posterior heel pain that should also be considered include plantar fasciitis, stress fractures of the calcaneus, and os trigonum syndrome. 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 bone 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. Treatment Most patients with posterior heel pain can find effective treatment through simple, nonsurgical treatments. It is important to understand the cause of the symptoms of pain before initiating any treatment program. For example, a stress fracture may require crutches and limited weight on the extremity, whereas another problem may have no restriction on weight bearing. For this reason, treatment should only be initiated once the diagnosis has been made. One of the most frequent treatments used for these conditions is gentle stretching of Achilles tendon and plantar fascia. By improving the mobility of the hindfoot, many of these conditions can be improved with a simple, non-invasive, non-medication treatment. Pain Beneath the Heel Pain beneath the heel is a different symptom from posterior heel pain. Pain underneath the heel, on the bottom of the foot, has several causes including: Tarsal Tunnel Syndrome Plantar Fasciitis Heel Spurs 2 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Agyekum EK, Ma K. Heel pain: A systematic review. Chin J Traumatol. 2015;18(3):164-9. doi:10.1016/j.cjtee.2015.03.002 Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci. 2012;17(8):799-804. Additional Reading Tu P. Heel Pain: Diagnosis and Management. Am Fam Physician. 2018;97(2):86-93. By Jonathan Cluett, MD Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit