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Heel pain may be a common complaint, but it should not be ignored. According to the American Academy of Orthopaedic Surgeons, most heel pain will resolve on its own, if given enough rest. Most posterior heel pain, or pain in the back of the heel, is the result of overuse, over training and improper footwear. In most cases, posterior heel pain will improve with ice, stretching and activity modification.
The Achilles tendon is a thick tissue that connects the calf muscles to the heel. It functions in conjunction with the muscles to lift the heel during walking and running. When the Achilles tendon gets overworked or overstretched, an irritation of the tendon can occur, known as Achilles tendinitis. According to MayoClinic.com, Achilles tendinitis is one of the common causes of pain in the back of the heel. The onset of pain is usually gradual, worse at the beginning of an exercise, and it may coincide with the addition of a new exercise routine. The pain is generally located within the thick cord of tissue, slightly above the heel.
Two bursae are located near the back of the heel, where the Achilles tendon attaches to the bone. Bursitis, or an inflammation of the bursae, may result in sharp pain at the back of the heel. According to the American Academy of Orthopaedic Surgeons, bursitis in the area of the heel may be caused by activities such as running or by wearing shoes that cut into this area. The constant rubbing of a shoe can inflame the area to the point of a painful bump developing on the heel. This is often treated by cutting a notch in the back of the shoe to accommodate the bump.
Posterior heel pain may be caused by an irritation of the spinal nerves as they exit the spine at the fifth lumbar to first sacral vertebrae. This is known as referred pain or radiculopathy. The patient with referred pain from the back may or may not feel back pain. Weakness of the calf muscle is often associated with the heel pain, and symptoms may change significantly depending on body posture. Sitting may increase the heel pain, and walking may reduce it. Referred pain is best treated by a physician who may prescribe antiinflammatory medications and physical therapy.