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Back of Heel Pain



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If the back of your heel hurts, make an appointment to see us right away – we are Seattle’s heel pain specialists and can usually relieve your pain very quickly in a very conservative manner. Surgery is not usually necessary but if conservative therapy fails is an option.

The back of the heel, figure 1, is the second most common location for heel pain (first is the bottom of the heel - usually due to plantar fasciitis. Swelling may be present and the back of the heel can be sore and tender to touch. Pain is often made worse by shoe pressure, standing and walking. Back of the heel pain is most common in those who wear tight shoes such as high heels, who are overweight or who are very active.
Figure 1 - bump back of heel.

Causes of Pain in the Back of the Heel
There are several common causes of pain in the back of the heel. Use the links to learn more about each condition. Three of the most common causes of pain in the back of the heel include:

  • Haglund Deformity (“Pump Bump”)
    Haglund’s deformity is a “bump” of bone on the upper portion of the back of the heel bone (calcaneus). More detail on Haglund Deformity can be found here.
  • Achilles Insertional Tendonitis / Tendinosis
    Achilles tendonitis at the point of attachment of the Achilles tendon into the heel bone. Detailed information on Achilles Tendonitis can be found here.
  • Achilles Calcific Insertional Tendinosis (Called AICT) Figure 2
    Bone spur back of heel and chronic Achilles tendonitis / tendinosis(Chronic tendonitis referred to as tendinosis) at the point of attachment of the Achilles tendon into the heel bone.
    Figure 2 - Heel spur back of heel (AICT)
  • Retrocalcaneal Bursitis
    Bursas are fluid filled sacs that occur normally throughout the body. They are like empty water balloons that fill with fluid when irritated. When this happens they can become extremely painful. The s prior to starting treating. Contact us at our convenient Seattle office for proper diagnosis and  treatment of your back of heel condition.ion.

    Physical Examination
    Patients with any of these posterior heel problems can have pain and tenderness over the back of the heel where the Achilles tendon attaches to the heel bone. Swelling may be present as may an enlargement of the bone Patients may walk with a limp and they may have difficulty taking a full stride.

    TREATMENT
    Non-Operative Treatment
    Our goal is always to treat these problems non-operatively and in most cases we are very successful at relieving posterior heel pain without surgery. In fact, surgery on this area can involve long recovery times, so we make every effort to avoid it. In our Seattle foot and ankle clinic, treatment for back of the heel pain may include the following:

    Heel Lift or the Use of a Shoe with a Moderate Heel: Walking in bare feet or a flat-soled shoe causes increased tightness on the Achilles tendon where it attaches into the heel. Using a heel lift, or a shoe with a moderate heel can help reduce the stress on the tendon and decrease the irritation caused by this condition.
    Custom foot orthotics: In several studies custom orthotics have been shown to be effective at reducing stress on the Achilles tendon by limiting both tension and “twist” on the tendon. We will evaluate your foot to determine if orthotics are a good option for your pain. Orthotics help about 60% of patients with back of the heel pain. Some pain in the posterior heel, however, does not respond to orthotic therapy.
    Achilles Strengthening: Specific types of strengthening have been shown to be effective in treating Achilles tendonitis. If you are a candidate, we will start you on an appropriate strengthening program.
    Immobilization: If pain and inflammation is severe, we may help the area calm down by immobilizing it in a walking boot for a short period of time.
    Calf Stretching: Regular stretching of the calf muscles and the Achilles tendon can help the compliance and length of the Achilles tendon. This makes the tendon more resistant to wear and tear.
    Anti-inflammatory Medication: Anti-inflammatory medications can help treat swelling and pain. These medications do not cure the underlying problem, but can be a valuable tool to help patients get over the initial problem. We then work with you to develop a treatment plan to prevent the problem from returning. Patients with a history of stomach problems, such as an ulcer or heartburn, should avoid these medications.
    Weight Loss: If you are carrying extra weight, weight loss is a critical part of alleviating your pain. A large percentage of patients with posterior heel pain are overweight. Working with a nutritionist, a trainer and your doctor in a concerted effort to lose substantial weight can be the most effective ways to eliminate back of the heel pain. Losing even 5 – 10 pounds can help enormously. The Achilles tendon is subject to forces equivalent to many times body weight during regular, daily activities such as walking and standing, so weight loss is critical.

    Operative Treatment
    Surgery for back of heel pain can have a long recovery so we recommend exhausting all conservative treatment before considering surgery. However, if all conservative treatment has failed, surgery may be indicated.

    Surgery may involve:

    1. Removing the extra bone on the back of the heel (the Haglund’s deformity)
    2. Removing the inflamed and thick retrocalcaneal bursa
    3. “Cleaning up” the Achilles tendon where it attaches into the back of the heel. Sometimes, if the tendon is in bad shape, we must partially or completely detach the tendon and then reattach it.
    4. Removal of bone spur and reattachment of the Achilles tendon.

    Surgical usually works well but may have a long recovery. Initially, the leg is immobilized to allow the surgical site to heal. Later, gentle range of motion exercises can be started. Often there is very limited or no weightbearing for the first 6 weeks after surgery. Gradually, we have patients increase activity. Significant improvement often takes 6-9 months.

    Potential Complications of Surgery for back of heel pain (All surgical procedures have chance of some type of complication)
    Specific Complications: Specifically for back of heel surgery, complications can include increased risk of Achilles tendon rupture but this is rare.
    General Complications: General complications for any foot and leg surgery include but not limited to infection., wound breakdown, injury to nerves. deep vein thrombosis, pulmonary embolism, prolonged healing.

    Overall, surgery may require long period on crutches and like any procedure has a risk of complications but generally provides satisfactory results for patients.

    Don’t live with back of heel pain. Contact us at our convenient Seattle office for treatment of your condition.ion.

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    For website errors ONLY email webmaster at WEBMASTER
    All pages on this website © 2005-2010
    Douglas Hale, DPM & Lawrence Huppin, DPM
    Foot and Ankle Center of Washington, Seattle
    The material provided on this web site is for informative purposes only.
    If you need specific medical advice, please contact the office for an appointment.

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WEBSITE DISCLAIMER
For website errors ONLY email webmaster at WEBMASTER
All pages on this website © 2005-2013
Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
The material provided on this web site is for informative purposes only.
If you need specific medical advice, please contact the office for an appointment.

Page copy protected against web site content infringement by Copyscape

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