Causes of Sharp Pain in the Back of the Heel
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.
Achilles Tendinitis
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.
- The Achilles tendon is a thick tissue that connects the calf muscles to 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.
Bursitis
Causes of Pain in the Toes
Learn More
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.
- 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.
Referred Pain
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.
- 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.
- Weakness of the calf muscle is often associated with the heel pain, and symptoms may change significantly depending on body posture.
Related Articles
References
- American Academy of Orthopaedic Surgeons: Heel Pain
- Podiatry Today: Conquering Posterior Heel Pain in Athletes
- MayoClinic.com: Heel Pain
- American Academy of Orthopedic Surgeons. (2017). Heel Pain. https://orthoinfo.aaos.org/en/diseases--conditions/heel-pain
- Tu P, Bytomski JR. Diagnosis of Heel Pain. Am Fam Physician. 2011 Oct 15;84(8):909-16. https://www.aafp.org/afp/2011/1015/p909.html
- Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician. 2011;84(8):909-16.
- Lim AT, How CH, Tan B. Management of plantar fasciitis in the outpatient setting. Singapore Med J. 2016;57(4):168-70. doi:10.11622/smedj.2016069
- Li HY, Hua YH. Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Biomed Res Int. 2016;2016:6492597. doi:10.1155/2016/6492597
- Gulati V, Jaggard M, Al-nammari SS, et al. Management of achilles tendon injury: A current concepts systematic review. World J Orthop. 2015;6(4):380-6. doi:10.5312/wjo.v6.i4.380
- Hong CH, Lee YK, Won SH, Lee DW, Moon SI, Kim WJ. Tarsal tunnel syndrome caused by an uncommon ossicle of the talus: A case report. Medicine (Baltimore). 2018;97(25):e11008. doi:10.1097/MD.0000000000011008
- Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress fractures of the foot and ankle in athletes. Sports Health. 2014;6(6):481-91. doi:10.1177/1941738113486588
- Tu P. Heel Pain: Diagnosis and Management. Am Fam Physician. 2018;97(2):86-93.
- Yi TI, Lee GE, Seo IS, Huh WS, Yoon TH, Kim BR. Clinical characteristics of the causes of plantar heel pain. Ann Rehabil Med. 2011;35(4):507-13. doi:10.5535/arm.2011.35.4.507
- Kucuksen S, Karahan AY, Erol K. Haglund syndrome with pump bump. Med Arch. 2012;66(6):425-7.
- Vaishya R, Agarwal AK, Azizi AT, Vijay V. Haglund's Syndrome: A Commonly Seen Mysterious Condition. Cureus. 2016;8(10):e820. doi:10.7759/cureus.820
- Pękala PA, Henry BM, Pękala JR, Piska K, Tomaszewski KA. The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study. Bone Joint Res. 2017;6(7):446-451. doi:10.1302/2046-3758.67.BJR-2016-0340.R1
- Helgeson K. Examination and intervention for sinus tarsi syndrome. N Am J Sports Phys Ther. 2009;4(1):29-37.
- Ma DL, Vano-galvan S. Piezogenic pedal papules. CMAJ. 2013;185(18):E847. doi:10.1503/cmaj.121963
- Fritz JM, Mcdonald JR. Osteomyelitis: approach to diagnosis and treatment. Phys Sportsmed. 2008;36(1):nihpa116823. doi:10.3810/psm.2008.12.11
- Yan L, Zong J, Chu J, et al. Primary tumours of the calcaneus. Oncol Lett. 2018;15(6):8901-8914. doi:10.3892/ol.2018.8487
- Narváez JA, Narváez J, Ortega R, Aguilera C, Sánchez A, Andía E. Painful heel: MR imaging findings. Radiographics. 2000;20(2):333-52. doi:10.1148/radiographics.20.2.g00mc09333
- Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl):S1-19. doi:10.1053/j.jfas.2010.01.001
- Noor S, Khan RU, Ahmad J. Understanding Diabetic Foot Infection and its Management. Diabetes Metab Syndr. 2017;11(2):149-156. doi:10.1016/j.dsx.2016.06.023
- Lui E. Systemic causes of heel pain. Clin Podiatr Med Surg. 2010;27(3):431-41. doi:10.1016/j.cpm.2010.04.004
- Podolsky R, Kalichman L. Taping for plantar fasciitis. J Back Musculoskelet Rehabil. 2015;28(1):1-6. doi:10.3233/BMR-140485
- Habets B, Van cingel REH, Backx FJG, Huisstede BMA. Alfredson versus Silbernagel exercise therapy in chronic midportion Achilles tendinopathy: study protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):296. doi:10.1186/s12891-017-1656-4
- Riskowski J, Dufour AB, Hannan MT. Arthritis, foot pain and shoe wear: current musculoskeletal research on feet. Curr Opin Rheumatol. 2011;23(2):148-55. doi:10.1097/BOR.0b013e3283422cf5
- Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int. 2007;28(1):20-3. doi:10.3113/FAI.2007.0004
- Sahu RL. Percutaneous planter fasciitis release under local anesthesia: A prospective study. Chin J Traumatol. 2017;20(2):87-89. doi:10.1016/j.cjtee.2017.01.002
- American Academy of Orthopedic Surgeons. (2017). Heel Pain.
- Buchbinder R. (2018). Patient education: Heel and foot pain (caused by plantar fasciitis) (Beyond the Basics). Isaac Z, ed. UpToDate. Waltham, MA: UpToDate Inc.
- Lareau CR, Sawyer G, Wang JH, DiGiovanni CW. Plantar and medial heel pain: diagnosis and management. J Am Acad Orthop Surg. 2014 Jun;22(6):372-80. doi: 10.5435/JAAOS-22-06-372
- Ma DL, Vano-Galvan S. Piezogenic pedal papules. CMAJ. 2013 Dec 10;185(18):E847. doi: 10.1503/cmaj.121963
- Tu P, Bytomski JR. Diagnosis of Heel Pain. Am Fam Physician. 2011 Oct 15;84(8):909-16.
- Vaishya R, Agarwal AK, Azizi AT, Vijay V. Haglund's Syndrome: A Commonly Seen Mysterious Condition. Cureus. 2016 Oct;8(10):e820. doi: 10.7759/cureus.820
Writer Bio
Based in Connecticut, Jody Murray, has been writing and teaching in the field of sports medicine since 1997. Murray has an M.A. in exercise physiology from UNC-Chapel Hill and a B.S. in athletic training from Springfield College. Murray is also a licensed acupuncturist.