Back of Heel Pain

Pain 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 Pain

If 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.

Tendinitis 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:

• Pain that occurs abruptly following a tendon strain, usually part way up the Achilles tendon.
• Sharp pain at the beginning of activity that decreases in intensity as exercise progresses.
• Pain that returns after exercise or after long periods of inactivity.
• Pain may subside when the Achilles tendon is allowed to rest.
• Pain becomes most significant when pushing off or jumping.
• Stiffness in your Achilles tendon when you wake up in the morning.
• Tender and warm to the touch.
• The Achilles tendon is irritated by heat but feels good when treated with cold compression and rest.

• A gradual onset of pain with no specific event known as the cause
• A thicker or swollen Achilles tendon
• Constant pain throughout exercise and even during daily activity
• A possible lump in the tendon approximately 2 inches above the heel
• Pain that increases when walking uphill or up stairs
• Pain and stiffness after long periods of rest
• Tender and warm to the touch
• Pain becomes most significant when pushing off or jumping
• A creaking feeling may occur when you press the tendon or move your ankle

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: Causes

Acute Achilles tendonitis may be caused by:

• Improper stretching before and after running and jumping exercises.
• Changes in foot wear (i.e. high heels, poor running shoes).
• An inflexible Achilles tendon (i.e. tendon with scar tissue from previous injury or wear and tear).
• An increase in training, training on uneven terrain or a change in terrain (i.e. hills).
• Weak or inflexible calf muscles (gastrocnemius or soleus muscles).

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.

• Rest - This is important for initial recovery for both Midpoint and Insertional Achilles Tendonitis; rest and elevation will help reduce pain, swelling and inflammation in the early stages of injury. This can be difficult when you have to carry on with daily activities, but resting and elevating your foot whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that put stress on your Achilles tendon until your pain and inflammation settles. Too much rest can also be harmful to achilles injuries because ankle joint immobility can actually cause stiffening in the joint. This is why rest should be used when reducing initial pain and swelling, but should not be considered for more long-term conservative treatment.

• Avoid Activities that Caused Your Injury - While resting your injury it's also important to avoid all activities that may have caused your tissue damage (especially any repetitive movement). Continuing on with regular activities can increase the severity of your injury, turning a mild to moderate case of tendon damage into a downward spiral of worsening damage that may eventually severely impact your life. Also, trying to 'work around' your injury will eventually give rise to over-compensation injuries in other areas of your body.
• Use a Cold Compress or Ice Pack - Cold is very effective at reducing pain and inflammation - use at the onset of the injury and during flareups.
• Use an Achilles TShellz Wrap^® (Circulatory Boost device) Once The Swelling is Down - You can use your own blood flow to maximize your rehabilitation, maintain healthy blood flow to your achilles and heel, decrease recovery time, reduce re-injury risk, and boost the bodys' healing rate. Promoting blood flow to the injury using a warming treatment will help to minimize the growth of scar tissue and increase flexibility. This is why we recommend TShellz Wrap before undergoing activity - an increase in flexibility should help reduce risk of further injury while also assisting in the battle against atrophy.
• Use an Achilles Support Wrap - to increase comfort and prevent further damage you may want to use a ankle support sleeve or brace to help support the area, reduce risk of further injury and reduce stress on the injured tissue. Some of these are also designed for heat retention to prevent further strain. They can be used until your injury is gone or during active sports for additional stability. Note that these should not be worn at all times, as they can limit muscle development, cut off circulation and impede healing of muscle tissue.
• Avoid Over Compensating for your Injury on your "'Healthy' (Non-Injured) Side - Many people will start limping or carrying objects with their opposite arm to compensate for their tendon injury. Our bodies can adapt easily to any changes, including a tendonitis injury. This quick adaptation could mean that you're already compensating for your injury without even knowing it!
  
  When you compensate for your injury by using your opposite ('healthy') arm, leg, shoulder, knee, foot, etc. - then you are putting more weight and pressure on that side of your body. In many cases, your dominant side was injured (if you're right-handed this would be your right side) so your weaker side is trying to pick up the slack! The pain, stiffness, swelling and inflammation you then get on your 'healthy' side is something referred to as 'over-compensation pain'. Over-compensating for your injury can lead to other injuries and so that's why over compensation should be avoided at all costs OR treated with the same conservative treatment methods as your tendon injury.
• Rehabilitative Stretching under supervision of a PT or doctor. The intent of this is to provide you with increased range of motion, pain relief and strengthening of the surrounding tissue of the joint. Doctors or surgeons typically won't perform a surgery until they feel that their patient has put effort into treating their injury with conservative treatment methods. This may include up to 4 to 6 months of visits to a PT clinic. If you haven't experienced any improvement in your condition during that time then surgery may be considered. Agressive PT approaches may focus on forced or manual manipulation of the achilles - this means your physical therapists will be trying to move your achilles past the point of comfort as they strive to increase range of motion and prevent further atrophy. This can be painful and end up making your injury worse if not done correctly. (reference: 1)
• Stretching - Stretching your joint in PT and at home will help you to regain your range of motion much faster than not stretching at all. Stretching in many ways is key maintaining good Range of Motion (ROM) in your joint, and stretching can be made much easier with use of a TShellz Wrap^® before to warm up soft tissue, and a Cold Compress or Ice Pack treatment after to prevent any return of swelling and inflammation.