So you’re out for a run – or on the field – or even just walking back to your desk at work and feel that ache at the back of your heel. It could be a dull ache that lingers throughout the day, or a sharp, stabbing pain that causes you to change the way you make each step. It’s probably your Achilles tendon… right? Well, it could be. Or it could be a number of other problems.
As we don’t believe in guesswork here at Cartwright Podiatry – today our podiatry team have shared the most common causes of pain at the back of the heel that we see and treat, how to tell them apart, and how to treat your pain regardless of whether it’s just started or has been plaguing you for years.
Bursitis is the inflammation of small fluid-filled sacs called bursae, or a ‘bursa’ (singular), that sit in over 150 spots in your body. Their job is to provide a smooth, lubricating surface for tendons and muscles to glide over, so they don’t rub against the bone and cause painful and damaging friction. When these bursae are exposed to high forces and repetitive stress, they can become swollen and painful, falling under the diagnosis of bursitis.
When it comes to the back of the heel, there’s a specific bursa called the retrocalcaneal bursa that sits between the Achilles tendon and the back of the heel bone, close to where the Achilles attaches. Damage to this bursa causes pain, redness and swelling at the back of the heel, with tenderness on both touching the back of the heel and when walking.
If you have a Haglund deformity, then you have a prominent bony bump at the back of your heel. It’ll be a noticeable projection that will have been gradually growing bigger over months or years, and while it may have started giving you pain recently, it’s likely that it may have been painless prior – aside from the odd redness or rubbing when you’ve worn tight footwear.
As the deformity grows, it can irritate the other structures at the back of the foot particularly the nearby bursa, causing pain, swelling and discomfort. The bigger the prominence gets, the more your shoes are likely to rub against the back of the heel and result in painful symptoms, as well as corns, callus and blisters.
A spur is a type of bony outgrowth (hard calcified area) that can develop at the point where the Achilles tendon attaches at the back of the heel. It grows in response to repetitive strain on the Achilles, as the body deposits calcium over many months to form the spur.
While some spurs can remain asymptomatic, others can irritate the Achilles tendon, causing pain and restricting the range of motion available at the ankle, especially when walking up and down stairs.
Os Trigonum Syndrome
Your Os Trigonum, if you have one, is a small extra bone that may be present at the back of your heel, just behind your ankle. If you have this accessory bone, you’ll be born with it – it doesn’t just develop overnight! Because of the place where it sits, when you point your toes downwards, the extra bone can become trapped and impinged between the heel bone and the top of the ankle – much like a nutcracker.
The symptoms of Os Trigonum syndrome include pain and swelling at the back of the heel, and a deep aching sensation – especially when you point your toes downwards, stand on your tiptoes, and during walking.
If you’re an adult that has stopped growing – this one won’t apply to you. The way your bones grow is through growth plates – specific areas where your bone-building cells add new bone. These areas aren’t as hard as the surrounding bone, making them more vulnerable to damage when the bone is exposed to tension and stress.
In Sever’s, it is the repetitive pull from the Achilles tendon, right next to the growth plate at the back of the heel, that causes pain and swelling. As physical activities like running sports cause the Achilles tendon to pull on the heel, it tends to come on during sports and ease with rest.
Your Achilles tendon is the strongest and biggest tendon in your body, regularly taking on forces exceeding three to four times your body weight. With the immense strain it can take on during physical activities – as well as everyday life – over time the tendon can become damaged and inflamed. This is known as Achilles Tendonitis. Over time, as the swelling settles but the degeneration of the tendon continues, this progresses into a more chronic state known as Achilles Tendinopathy.
The result is pain and tenderness at the back of the heel, particularly any time that the Achilles tendon is engaged, which tends to be during running and jumping activities.
How Do I Know What’s Causing My Heel Pain?
Truthfully, it can be very hard to tell, especially with overlapping symptoms present in the same areas. The only way to have a definitive diagnosis is to get one from an experienced professional. This is what we do with a comprehensive biomechanical assessment.
In this assessment, we check everything from the range of motion in your joints, to your muscle strength and gait characteristics, to exactly which structures are producing what symptoms. Based on your symptoms, we can almost always diagnose the cause of your heel pain. In the odd situations where your symptoms are indicative of numerous conditions, we can send you for medical imaging to obtain a final diagnosis.
Shockwave Treatment For Heel Pain
Effectively treating pain at the back of the heel can be difficult at times. Unlike our arms or shoulders that we can pop in a sling and largely avoid using, we still need to continue to use our feet, joints, muscles and tendons with every step. This means that treatment needs to be targeted and effective – which is exactly why we are the first and only clinic in the area to offer innovative and proven shockwave treatment for our patients.
Shockwave works by emitting acoustic pressure waves into the heel (or any part of the body that it is applied to), that can help decrease pain, reduce inflammation, facilitate or reboot the body’s healing and repair process in both new and longstanding injuries, stimulate tendon regeneration, disintegrate tendon calcifications, and more. When it comes to shockwave, we love that:
- There are no painful injections that break the skin
- There are no medications that may have undesirable side effects
- It’s non-invasive – it does not penetrate the skin
- It’s a non-surgical option to reduce the risk of adverse effects
- It has a relatively short treatment time per session – ~30 minutes per session
- It stimulates the body’s own processes to improve healing and repair
Need help with your heel pain?
When it comes to heel pain, the earlier the treatment, the better. Whether your heel pain is new or has been bothering you for years, our experienced podiatry team here in Tahmoor, Sydney is here to help. Book your appointment with us by calling (02) 8405 6850 or book online.