Causes of Posterior Heel Pain - Achilles Tendinitis
Chronic Achilles Tendinitis: Symptoms
Chronic Achilles Tendinitis: Causes
- Acute Achilles tendinitis that has gone untreated.
- Not warming up or stretching before and after exercise.
- Wearing high heels over a long period of time. High heels cause the calf muscles to shorten (contract) providing less slack in the Achilles tendon.
- An inflexible Achilles tendon (i.e. tendon with scar tissue from previous injury or wear and tear or acute Achilles tendinitis).
- Training on uneven terrain or a change in terrain (i.e. hills) .
- Weak or inflexible calf muscles (gastrocnemius or soleus).
- Flat feet (also called pes planus or fallen arches) can cause extra stress on the Achilles tendon.
- Overpronation of the foot (rolling your foot inward too much when you walk or run which may be due to having high arches).
- Bony growths around the heel (sometimes caused by arthritis) which irritate the Achilles tendon.
- Heel bones can very in shape and size from person to person. With such variations, a small heel bone can put extra stress on your Achilles tendon causing you to more of a chance of damage then the next person. An irregular shape calcaneus (heel bone) can cause the Achilles tendon to twist causing further irritation.
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: Treatment
Your 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 Bursitis
A 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: Symptoms
When you suffer from Achilles bursitis it will be most noticeable when you begin an activity after rest:
- Pain at the back of the heel, especially with jumping, hopping, tip-toeing, walking or running uphill or on soft surfaces. If tendonitis is also present, the pain can radiate away from the bursa.
- Direct pressure on the bursa will exacerbate the pain and should be avoided if possible.
- Tenderness and swelling which might make it difficult to wear certain shoes on the feet.
- As the bursa becomes more inflamed you will experience swelling and warmth. In severe cases, the bursa will appear as a bump, called a "pump bump", and is usually red, and extremely tender. Swelling can cause difficulties moving as the range of motion in the ankle can be affected.
- Limping due to the pain may occur
- If you press on both sides of the inflamed heel, there may be a firm spongy feeling.
- Weakness in the tendons and muscles surrounding the bursa can develop as the pain worsens and the inflammation in the area spreads.
- Possibly a fever if you are suffering from septic bursitis (You will need to see a doctor for medication to get rid of the infection).
- For individuals who wear high-heeled shoes frequently, they may also feel an increase in pain when they are wearing flat shoes. When wearing high-heels, the calf muscles and Achilles tendon remain in a shortened position. When flat shoes are worn it causes the calf muscles and Achilles tendon to stretch more than usual causing the tendon to tighten around the heel bone causing irritation.
Achilles Bursitis: Causes
- Tight shoes or shoes that do not fit properly can cause extra pressure on the back of the heel.
- Athletes overtraining or runners increasing their distance to quickly.
- Haglund deformity, a bony enlargement on the back of the heel bone, during dorsiflexion causes an impingement of the bursa between the Achilles tendon and the heel bone.
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 Heel
Referred 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.
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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!