![]() | Back of Heel PainPain at the back of the heel is termed "posterior heel pain". Most posterior heel pain happens due to overuse, poor fitting shoes or sandals or from overtraining. If you are experiencing pain at the bottom of the heel, the cause is most likely plantar fasciitis. So, What Is Causing My Posterior Heel PainIf you are experiencing pain at the back of your heel that is not due to a skin injury (such as a blister) or a bone injury (chipped bone or fracture) then it is almost certain that you are suffering from achilles tendinitis, bursitis or referred pain. Causes of Posterior Heel Pain - Achilles TendinitisTendinitis can be classified in two categories - acute tendinitis or chronic tendinitis. Acute tendinitis means you have experienced a recent injury in which your achilles tendon has become strained or partially torn. Chronic tendinitis means that you have had this condition for a lengthy period of time. A chronic case occurs when the Achilles tendon becomes inflamed over a period of time. This is often due to repetitive overuse, irritation or may be a result of acute tendinitis that has been left untreated or has not been allowed sufficient rest. It is common that the tendon becomes enlarged and inflexible due to the buildup of scar tissue. ![]() Acute Achilles tendinitis is typically the result of an injury or specific event that caused a strain or tearing of the Achilles tendon. When the fibers of a tendon are torn, they become inflamed and swollen causing pain and tenderness in the area which can also result in difficulty flexing the foot during regular movements, such as walking and jumping. Most commonly, this condition is seen in athletes who sit at a desk all week and then plays softball or tennis on the weekend. The aftereffect is tendon strain (mild tears) creates inflammation and pain and can lead to tendinitis. This condition could also be created if the tendon is strained from a sudden trauma such as a fall or misstep. Achilles tendinitis can occur at the insertion point of the tendon (referred to as insertional tendinitis) at the calcaneus (heel bone) or mid way up the Achilles tendon (referred to as non-insertional tendinitis or "achilles tendinitis a the midpoint"). The most common area to be affected by acute tendinitis is approximately 1/3 of the way up the tendon, 2.5 inches from where it attaches to the heel bone. This part of the Achilles tendon is at most risk of tendinitis and other tendon injuries because it receives less blood flow than other parts of the tendon. Acute Achilles Tendinitis: Symptoms![]() If you are suffering from Acute Achilles Tendinitis you will most likely be experiencing:
Chronic Achilles Tendinitis: Symptoms
If you feel a sharp pain, as though you've been hit in the back of the ankle, and hear a "pop" sound, your Achilles tendon has likely ruptured. A ruptured (completely torn) Achilles tendon can occur when the Achilles tendon is overstressed to the point of tearing. It will be very difficult for you to walk or move your ankle if this is the case. Acute Achilles Tendinitis: CausesAcute Achilles tendonitis may be caused by:
Achilles tendinitis is one of those injuries that can really bring down the quality of your life. Anyone - young or old - can suffer from this injury, and if you're active this condition will keep you from doing the things you love to do. It will even start interrupting any of your normal daily tasks and make living life harder than it really needs to be. Chronic Achilles Tendinitis: Causes
![]() Chronic Achilles tendinitis can be a difficult condition to treat due to the build up of scar tissue on the tendon. Scar tissue can form in any direction. Ultimately what causes stiffening, entrapping a nerve, restricting movement, less elasticity, poor circulation, flexibility and leaves the tendon more chance to further injury. Achilles Tendinitis: TreatmentYour doctor will prescribe a series of conservative treatment protocols for you to follow. In most cases, a conservative treatment protocol will be enough to heal the injury, though in cases such as significant tearing or a fully ruptured tendon, you will most probably require surgery. It is generally understood by doctors and surgeons, that surgery will introduce more scar tissue into the any already damaged tissue. This added scar tissue will be problematic, requiring more PT and conservative treatment options post-surgery. If not dealt with properly, your Achilles tendon injury could end up in worse condition than before the surgery! This is why surgery is only performed as a last resort. Some conservative treatment methods recommended include:
Read more about conservative treatment options for achilles tendonitis by clicking here. Causes of Posterior Heel Pain - Achilles BursitisA bursa is a sac of synovial fluid, rich in protein and collagen, that lies between a tendon and a bone to help the tendon glide smoothly over the bone. There are 2 bursae that surround the Achilles tendon to protect it from friction. The retrocalcaneal bursa lies between the tendon and the back, or posterior surface, of the heel bone (calcaneus). This is a "true" bursa that is present from birth. It acts as a cushion between these two structures to protect the tendon from friction against the heel bone. ![]() The larger subcutaneous calcaneal bursa lies overtop of the tendon at the lower part of the heel where the tendon joins to the heel bone. This bursa develops as you age, an "adventitious" bursa, to protect the tendon from friction at the back of the heel. Bursitis occurs when a bursa is irritated from frequent pressure and it becomes inflamed. When one or both of these bursa become inflamed it is generally referred to as Achilles bursitis because of the bursa's proximity to the Achilles tendon. In some cases, an inflamed bursa can become infected with bacteria (referred to as septic bursitis) and it is necessary to see a doctor to get rid of the infection. Due to the proximity to the area on the Achilles tendon, Achilles bursitis is often mistaken for tendinitis. Achilles bursitis is a common overuse injury in runners, ice skaters and other athletes. Achilles Bursitis: SymptomsWhen you suffer from Achilles bursitis it will be most noticeable when you begin an activity after rest: ![]()
Achilles Bursitis: Causes
Achilles Bursitis: Treatments![]() Relieving the symptoms of bursitis initially focuses on taking the pressure off the bursa. This can be done with proper cushioning, inserts, or footwear but may require surgery if it is a bone formation problem (i.e. Haglund's Deformity). If your bursitis is caused by an infection (septic bursitis), the doctor will probably drain the bursa sac with a needle and perscribe antibiotics to treat the infection. For non-infectious bursitis, the preliminary treatment starts with conservative treatment options. Such options typically include cold compression and Circulation Boost. Surgery to remove the inflamed bursa is normally not required for bursitis, however if you fail to see improvement with the conservative treatments, your physician may recommend surgery to remove the bursa completely. Although this removes the problem of an inflamed bursa, you are left with less cushioning in your joint which can lead to other conditions such as fraying of the tendons, muscles or ligaments in the treated area. Eventually, fraying can lead to increasing weakness and rupture in severe cases. Read more about conservative treatment options for achilles bursitis by clicking here. Causes of Posterior Heel Pain - Referred Pain at Back of HeelReferred pain is the strangest issue to get your head around and it is not exactly a common issue, but can manifest itself via an irritation of the spinal nerve between the fifth lumbar and the first sacral vertebrae. In cases such as referred pain, it goes without saying that you should see a physician to get a proper diagnosis as well as proper treatment. In such instance, a proper treatment may include some back treatments, recommendations for change in posture, anti-inflammatory medications and PT. Learn More About Achilles Injuries & TreatmentsI want to learn more about Achilles Surgery & Post-Surgery Recovery I want to learn more about Circulation Boost I want to learn more about Ice & Heat: Which Is Better For The Achilles? I want to learn more about Stretching for the Achilles | ![]() Achilles Tendon Facts There are over 250,000 achilles tendon injuries each year in the US. Achilles tendon ruptures are common in people between the ages of 30 and 50. In runners, too rapid an increase in mileage, hill training without proper strengthening, and recent or inadequate changes to running gear can cause injuries to the Achilles tendon. Achilles tendonitis accounts for an estimated 11% of running injuries. 3-5% of athletes are forced to leave their sports career due to Achilles tendon overuse injuries that go untreated. Medications mask the pain but do very little in the healing of Achilles tendonitis. A fully ruptured tendon REQUIRES surgery. It will not heal on its own. Achilles tendonitis and Achilles tendinitis are the same thing. Continually using your Achilles tendon while it is injured will lead to a more serious and/or chronic injury. ![]() ![]() ![]() ![]() ![]() ![]() ![]() ![]() |