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 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:
Figure 2 - Heel spur back of heel (AICT)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:
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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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.
WEBSITE DISCLAIMER
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.
